Friday, June 23, 2017

A Novel Evidence-Based Periodontal Prognosis Model

,

Abstract

Objective

Patients with periodontal disease and the dental professionals responsible for their care want to know which teeth are expected to respond favorably to periodontal treatment and which teeth are likely to be lost in the short and long term. A number of different periodontal prognosis systems have been previously proposed but do not consider important patient-level factors, such as smoking and diabetic control, in the calculation of the expected outcome and often use subjective measures that introduce potential inaccuracies. The aim of this report is to translate the best available evidence on periodontal prognosis into a clinical model to facilitate decision-making and improve patient outcomes.

Methods

Criteria for an ideal prognostic system were proposed and used to assess the previously reported models. With an emphasis on the inclusion of patient-level modifiers (PLMs) and the exclusive use of objective parameters, a new evidence-based model was developed.

Results

This report proposes a new tooth-level prognosis model that uses 9 evidence-based quantifiable parameters to provide a prognosis of secure, doubtful, poor, or irrational to treat. Six tooth-level risk predictors (bone loss:age, pocket depth, furcation involvement, infrabony defects, anatomical factors, and mobility) and 3 PLMs (smoking, diabetes, and bleeding on probing) are used to determine the expected course of disease with specific reference to the suitability of the tooth for future dental treatment.

Conclusions

PLMs must be considered when determining the prognosis of a tooth with periodontal disease. The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as possible to facilitate its adoption in clinical practice. It will be retrospectively and prospectively validated to determine its ability to accurately predict the course of disease.

Thursday, June 22, 2017

Erbium Laser Technology vs Traditional Drilling for Caries Removal: A Systematic Review with Meta-Analysis



Abstract

Objective

The study aimed to assess the efficacy of erbium laser technology compared with traditional drilling for caries removal.

Methods

A systematic search was conducted through Medline via PubMed, Embase, Cochrane databases, CNKI till December 2016. Randomised controlled trials, quasi-randomized controlled trials, or controlled clinical trials with data comparing the efficacy of erbium laser technology versus traditional drilling for caries removal were included.

Results

Fourteen studies were selected in our meta-analysis. Erbium laser technology showed an increased time when removing caries compared with drilling (mean difference: 3.48, 95% confidence interval: 1.90-5.06, P < .0001). However, erbium laser technology reduced the requirement for local anesthesia (risk ratio: 0.28, 95% confidence interval: 0.13-0.62, P = .002). Erbium laser technology was also not significantly different to traditional drilling with regard to restoration loss, pulpal vitality, and postoperative sensitivity.

Conclusions

Erbium laser technology showed an increased time for cavity preparation compared with traditional drilling. However, erbium laser technology reduced the requirement for local anesthesia. There was no significant difference between erbium laser technology and traditional drilling regarding restoration loss, pulpal vitality, and postoperative sensitivity.

Wednesday, June 21, 2017

CAD/CAM-fabricated ceramic implant-supported single crowns made from lithium disilicate: Final results of a 5-year prospective cohort study


Abstract

Background

All-ceramic bilayer systems suffer from technique-sensitivity, resulting in increased technical complication rates. This might be overcome by monolithic reconstructions, facilitating digital workflows.

Purpose

To evaluate the clinical and patient-reported outcome of CAD/CAM-fabricated implant-supported single crowns (ISCs) made of lithium disilicate (LS2) cemented on ceramic implants 5 years after implant installation.

Materials and methods

Twenty-four patients were included in the study. All participants received a one-piece ceramic implant in anterior (4 incisors) and posterior regions (10 premolars, 10 molars). LS2 crowns were computer-aided designed (CAD), manufactured (CAM) and adhesively luted onto the implants. Follow-ups were performed yearly up to 60 months after implant installation. The survival/success rates of the restorations were calculated according to modified US Public Health Service criteria as follows: Clinically relevant defects that could be repaired intraorally were accepted for survival, whereas small-area chippings, roughness (ø < 2 mm), slightly soundable marginal gaps, minimal undercontours/overcontours, and tolerable color deviations were accepted for success. Kaplan-Meier plots were used for the success/survival analyses. Furthermore, patient-reported outcome measures (PROMs) were assessed by applying visual analog scales (VAS). Linear (PROMs) and logistic (USPHS criteria) mixed models were fitted to evaluate time effects on response variables.

Results

Twenty-two ISCs could be evaluated 55.2 ± 4.2 months after prosthetic delivery. Two patients were reported as drop-outs (1 died, 1 moved abroad). No failures were observed, resulting in 100% survival. At two ISCs, a major-roughness had to be treated. This resulted in a Kaplan-Meier success estimate of 91.7% (95%CI: 70.6%-97.9%). Compared with pretreatment, all surveys at prosthetic delivery except for self-esteem (P = .375) showed significantly improved VAS scores. No decrease in satisfaction could be observed over time until the end of follow-up (P ≥ .056).

Conclusion

Concerning survival/success rates and PROMs, the evaluated crown-implant system showed favorable mid-term results. To date, there are no comparable data available for implant-supported ISCs made of LS2.

Tuesday, June 20, 2017

Comparison of dimensional accuracy of conventionally and digitally manufactured intracoronal restorations


The Journal of Prosthetic Dentistry


Available online 2 June 2017

Abstract

Statement of problem

Advances have been made in digital dentistry for the fabrication of dental prostheses, but evidence regarding the efficacy of digital techniques for the fabrication of intracoronal restorations is lacking.

Purpose

The purpose of this in vitro study was to compare the dimensional accuracy of intracoronal restorations fabricated with digital and conventional techniques.

Material and methods

A sound mandibular molar tooth received a standard onlay preparation, and onlays were fabricated with 1 of 3 fabrication techniques. In group CC, the onlays were made after conventional impression and conventional fabrication of a resin pattern. In group CP, the onlays were made after conventional impression and 3-dimensional (3D) printing of the pattern. In group IP, the onlays were made after intraoral scanning, and 3D printing produced the resin pattern. Ten specimens in each group (N=30) were evaluated. Glass-ceramic restorations were fabricated using the press technique. The replica technique was used to assess the marginal fit. Each replica was assessed at 8 points. One-way ANOVA was used to compare the marginal discrepancy among the 3 groups. The Tukey honest significant differences test was applied for pairwise comparisons of the groups (α=.05).

Results

No significant differences were noted in the marginal discrepancy at the gingival margin among the 3 groups (P=.342), but significant differences were noted among the 3 groups in the pulpal (P=.025) and lingual (P=.031) areas. Comparison of the absolute discrepancy among the 3 groups revealed that only groups CC and CP were significantly different (P=.020) from each other.

Monday, June 19, 2017

The efficacy of non-narcotic analgesics on post-operative endodontic pain: A systematic review and meta-analysis



Summary

The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method. Meta-regression analysis was conducted to examine the associations between effect sizes and study-level covariates (P < 0·05). The results showed that administration of non-narcotic analgesic was more effective than placebo in the management of post-operative pain, resulting in a lower pain scores with a standardised mean difference of −0·50 (95% CI= −0·70, −0·30), −0·76 (95%CI= −0·95, −0·56), −1·15 (95% CI= −1·52, −0·78), −0·65 (95% CI= −1·05, −0·26) for immediately after the procedure, 6−, 12− and 24 h post−operative follow-ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta-regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow-ups. We concluded that the clinicians can manage post-operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.

Friday, June 16, 2017

Canadian Dentists Turn to Financial Practice Management CE, Patient Financing and Promotion on Social Media as Dental Practice Consolidation Continues



Toronto, ON – June 6, 2017 – The fundamental shift in the make-up of the Canadian dental practice detected in previous reports is continuing, according to results from the DIAC (Dental Industry Association of Canada) Twenty-First Annual Future of Dentistry Survey. All of the following points may reflect on the impact of the current economic situation on the dental practice in Canada:
  •   There are now more dentists per practice on average, with a record 13% of practices with five or more dentists. This was 3.4% in 2016 and an average of 6.3% the last 14 years.
  •   There are now more operatories per practice (72% of respondents had four or more operatories. Of these, an all-time high of 30% had five or more). Almost 1⁄4 (22%) of respondents were planning on adding at least one operatory in the next two years.
  •   The number of hygiene days per practice is increasing overall (44% of respondents in 2017 had 5 or more hygiene days per week, as compared to 40.4% last year and the average of 38.5% the last ten years).
  •   At the same time, the average number of patients treated per day continues to decline. While influenced by specialist respondents, on an overall basis, dentists treated 12 patients in an average day as compared to the average of 12.5 patients over the last ten years.83% stated they treated less than 15 patients a day (as opposed an average of 77.5% over the last four years).
    It is little wonder that “Getting More Patients” was the top challenge that respondents intended to address in 2017 (as well as the Top Metric for Success in the opinion of 83%), with “Financial/paying bills/overhead” a close second.
    Many dentists have responded by moving into Multi-practice (Group Practice). While the majority (59%) of respondents stated they were in a solo practice, more than a third (36%) were now in a group practice and a further 4% in Corporate dentistry. The two key advantages of a multi-practice structure attracting those who were in that type of practice were Associate Support (51%) and Buying Power (30%).
    Dentists are also now focusing their Practice Management CE activities on Financial aspects. While all four of the highest rated Practice Management topics for 2017 related to building the business of the practice (Ranked in order from highest: Revenue Enhancement/Expense Management; Fraud Protection, Marketing the Practice, and Communication/Case Presentation), the top focus has switched from Marketing to “the Numbers”, which may be a reflection on the economic situation. At the same time, member in Study Clubs was up overall; with 45.1% of respondents stated they belonged to one or more as compared to the average 37.9% of the previous eight years.
The majority (65%) of dental practices now offer patient financing in some fashion. Almost one-half (47%) of respondents offered in-house financing while 19% used third party financing.
Social Media continues to climb the list of Practice-Building Tools utilized at 45% of respondents, now second to “Asking for referrals” and progressively trending upward from 13% in 2012 when the question was first asked. This movement to on-line promotion mirrors where dental patients are telling practitioners they are getting information on dental treatment options. According to the survey, Internet achieved an all-time high rating and was ranked as the top patient source for the second straight year. This was followed by the more traditional sources of Family members, friends, etc. and Dentist/Dental Team presentations.
A total of 335 practicing Canadian dentists responded to this year’s survey with a good proportional distribution across all regions of the country. Based on this response rate, overall 2017 survey results have an accuracy of +/- 5.4% 19 times out of 20.
Source: Twenty-First Annual Future of Dentistry Survey
Dental Industry Association of Canada / Eric P. Jones & Associates Inc.

Thursday, June 15, 2017

Comparison of dimensional accuracy of conventionally and digitally manufactured intracoronal restorations

The Journal of Prosthetic Dentistry

Abstract

Statement of problem

Advances have been made in digital dentistry for the fabrication of dental prostheses, but evidence regarding the efficacy of digital techniques for the fabrication of intracoronal restorations is lacking.

Purpose

The purpose of this in vitro study was to compare the dimensional accuracy of intracoronal restorations fabricated with digital and conventional techniques.

Material and methods

A sound mandibular molar tooth received a standard onlay preparation, and onlays were fabricated with 1 of 3 fabrication techniques. In group CC, the onlays were made after conventional impression and conventional fabrication of a resin pattern. In group CP, the onlays were made after conventional impression and 3-dimensional (3D) printing of the pattern. In group IP, the onlays were made after intraoral scanning, and 3D printing produced the resin pattern. Ten specimens in each group (N=30) were evaluated. Glass-ceramic restorations were fabricated using the press technique. The replica technique was used to assess the marginal fit. Each replica was assessed at 8 points. One-way ANOVA was used to compare the marginal discrepancy among the 3 groups. The Tukey honest significant differences test was applied for pairwise comparisons of the groups (α=.05).

Results

No significant differences were noted in the marginal discrepancy at the gingival margin among the 3 groups (P=.342), but significant differences were noted among the 3 groups in the pulpal (P=.025) and lingual (P=.031) areas. Comparison of the absolute discrepancy among the 3 groups revealed that only groups CC and CP were significantly different (P=.020) from each other.

Conclusions

Within the limitations of this in vitro study, the conventional method yielded more accuracy than the 3D printing method, and no differences were found between the methods which used the 3D printer (groups CP and IP).

Wednesday, June 14, 2017

Accuracy of four intraoral scanners in oral implantology: a comparative in vitro study

BMC Oral HealthBMC series – open, inclusive and trusted201717:92
DOI: 10.1186/s12903-017-0383-4
Received: 13 April 2017
Accepted: 23 May 2017
Published: 2 June 2017

Abstract

Background

Until now, only a few studies have compared the ability of different intraoral scanners (IOS) to capture high-quality impressions in patients with dental implants. Hence, the aim of this study was to compare the trueness and precision of four IOS in a partially edentulous model (PEM) with three implants and in a fully edentulous model (FEM) with six implants.

Methods

Two gypsum models were prepared with respectively three and six implant analogues, and polyether-ether-ketone cylinders screwed on. These models were scanned with a reference scanner (ScanRider®), and with four IOS (CS3600®, Trios3®, Omnicam®, TrueDefinition®); five scans were taken for each model, using each IOS. All IOS datasets were loaded into reverse-engineering software, where they were superimposed on the reference model, to evaluate trueness, and superimposed on each other within groups, to determine precision. A detailed statistical analysis was carried out.

Results

In the PEM, CS3600® had the best trueness (45.8 ± 1.6μm), followed by Trios3® (50.2 ± 2.5μm), Omnicam® (58.8 ± 1.6μm) and TrueDefinition® (61.4 ± 3.0μm). Significant differences were found between CS3600® and Trios3®, CS3600® and Omnicam®, CS3600® and TrueDefinition®, Trios3® and Omnicam®, Trios3® and TrueDefinition®. In the FEM, CS3600® had the best trueness (60.6 ± 11.7μm), followed by Omnicam® (66.4 ± 3.9μm), Trios3® (67.2 ± 6.9μm) and TrueDefinition® (106.4 ± 23.1μm). Significant differences were found between CS3600® and TrueDefinition®, Trios3® and TrueDefinition®, Omnicam® and TrueDefinition®. For all scanners, the trueness values obtained in the PEM were significantly better than those obtained in the FEM. In the PEM, TrueDefinition® had the best precision (19.5 ± 3.1μm), followed by Trios3® (24.5 ± 3.7μm), CS3600® (24.8 ± 4.6μm) and Omnicam® (26.3 ± 1.5μm); no statistically significant differences were found among different IOS. In the FEM, Trios3® had the best precision (31.5 ± 9.8μm), followed by Omnicam® (57.2 ± 9.1μm), CS3600® (65.5 ± 16.7μm) and TrueDefinition® (75.3 ± 43.8μm); no statistically significant differences were found among different IOS. For CS3600®, For CS3600®, Omnicam® and TrueDefinition®, the values obtained in the PEM were significantly better than those obtained in the FEM; no significant differences were found for Trios3®.

Conclusions

Significant differences in trueness were found among different IOS; for each scanner, the trueness was higher in the PEM than in the FEM. Conversely, the IOS did not significantly differ in precision; for CS3600®, Omnicam® and TrueDefinition®, the precision was higher in the PEM than in the FEM. These findings may have important clinical implications.

Tuesday, June 13, 2017

Response of carious enamel to TiF4 varnish treatment under diverse cariogenic activities in situ



Abstract

OBJECTIVE

To compare the effect of TiF4 and NaF varnishes on pre-demineralized bovine enamel under different cariogenic activities in situ.

METHODS

Twenty subjects participated of this in situ study with 3 crossover phases (14 days each), in which they wore palatal appliances containing demineralized bovine enamel samples (8 samples/appliance for phase) treated with TiF4, NaF (all with 2.45% F) or placebo varnish. The samples were subjected to different cariogenic conditions (1. absence of biofilm accumulation and sucrose exposure; 2. presence of biofilm and absence of sucrose exposure; 3. presence of biofilm and 20% sucrose exposure 4x/day; 4. presence of biofilm and 20% sucrose exposure 8x/day). All were exposed to fluoride dentifrice (2x/day). The mineral content and lesion depth were evaluated using transverse microradiography (TMR) and the data were subjected to RM two-way ANOVA/Bonferroni tests (p<0 .05="" p="">

RESULTS

TiF4 varnish significantly increased the remineralization of artificial carious lesions compared to placebo, regardless of the cariogenic activity. On the other hand, the remineralizing effect of NaF varnish was dependent on the cariogenic activity. For NaF, remineralization happened only in conditions 1 and 3 compared to placebo varnish (p < 0.0001). NaF was unable to prevent further demineralization under biofilm accumulation and sucrose exposure 8x/day (condition 4). In the absence of fluoride treatment, demineralization happened in all conditions, except in the condition 1.

CONCLUSION

Therefore, 4% TiF4 varnish was the only treatment able to improve enamel remineralization regardless of the cariogenic activity, while NaF varnish failed in preventing further demineralization under high cariogenic activity in situ.

CLINICAL SIGNIFICANCE

4% TiF4 varnish showed better remineralizing effect compared to NaF varnish, which was seen regardless of the cariogenic activity. This is a promising finding to support the indication of TiF4 in the clinic.

Monday, June 12, 2017

Antibiotic treatment to prevent post-extraction complications: a monocentric, randomized clinical trial. Preliminary outcomes.


Minerva Stomatol. 2017 May 31. doi: 10.23736/S0026-4970.17.04047-X. [Epub ahead of print]

Abstract

BACKGROUND:

Tooth extraction is a very common procedure in oral surgery. Despite this, very little information is available in the literature as to the antibiotic management of the patient. The aim of this study is to evaluate whether the antibiotic prophylaxis could be beneficial in preventing post- extraction local complications and whether the use of a probiotic could help reduce the antibiotic gastro-intestinal side effects.

MATERIALS AND METHODS:

111 patients meeting the inclusion criteria were initially included in this randomized clinical trial and randomly allocated to one of the three experimental groups according to a computer-generated randomization list. Patients allocated to the group 1 were given amoxicillin+clavulanic acid (2 grams/day for 6 days), patients allocated to the group 2 received antibiotic+ probiotic (Bifidobacterium longum + lactoferrin) and patients allocated to the group 3 received no antibiotic therapy after the extraction. To evaluate post-extractive complications, controls were performed at days 7, 14 and 21 after the extraction.

RESULTS:

At T1 pain at the surgical site was present in the 48%, 30% and 71.4% of the patients belonging respectively to the antibiotic alone group, to the antibiotic+probiotic group and to the control group. The mean Numeric Rating Score (NRS) score was 1.56±1.91, 1.08±1.93, 2.02±2.27 respectively (P=0.0498). Two patients belonging to the control group experienced dry socket. In addition, 9 patients (33.3%) in the antibiotic-alone group and 1 patient (2.7%) in the antibiotic+probiotic group reported intestinal distension (p=0.0012), 7 days after surgery. Finally, diarrhea was recorded in 5 patients of the antibiotic alone group (18.5%), on the other hand, no patients of the antibiotic+probiotic group and the control group reported diarrhea.

CONCLUSIONS:

Post-extractive complications observed in each group have been mild and fast to resolve. The antibiotic administration showed a decrease in pain suffered by patients but a higher incidence of gastro-intestinal side effects, such as abdominal distension and diarrhea, which seemed to be relieved by the concomitant use of the probiotic.

Friday, June 09, 2017

Evaluation of Compressive Strength and Sorption/Solubility of Four Luting Cements

Journal of Dental BioMaterials
Vol 4, No 2 (2017)

Abstract


Abstract:
Statement of Problem: Compressive strength (CS) and sorption/solubility of the luting cements are two associated factors. Searching a correlation between sorption/solubility and compressive strength of various luting cements is required.
Objectives: To measure the water sorption/solubility, and compressive strength of three resin-based and one conventional glass ionomer (CGI) luting cement after 1 and 24 h of immersion in distilled water and to determine if there is any correlation between those properties found.
Materials and Methods: Four luting cements were investigated. For each material, 10 disc shaped specimens were prepared for measuring the sorption/solubility. The specimens were cured according to the manufacturer’s instructions, and the sorption/solubility were measured in accordance with the ISO 4049’s. For testing the compression strength, for each material 16 cylindrical specimens were prepared by insertion of cements into a stainless steel split mould. The specimens were cured, divided into groups of 8, and then stored in distilled water at (37 ± 1)°C for 1 and 24 h. The test was performed using the universal testing machine, the maximum load was recorded and CS was calculated. The data were analysed using SPSS software version 18. One-way ANOVA, post-hoc Tukey’s test and Pearson’s correlation coefficient were performed.
Results: G-CEM had the highest mean CS (153.60± 25.15) and CGI luting had the lowest CS (21.36±5.37) (p <0 .001="" 24="" after="" all="" almost="" an="" cs="" except="" for="" h="" increase="" materials="" mean="" relyx="" showed="" sup="" values="">TM
U200 which showed a slight reduction. However, no statistically significant difference was founded (all p > 0.05). The lowest mean sorption/solubility value was for RelyXTM U200 and Panavia F, and the highest for CGI luting (all p < 0.001).Conclusions: The compressive strength of all cements did not necessarily increase after 24 h and varied depending on the materials. There was a strong reverse correlation between sorption and CS values after both 1 and 24 h immersion. It may be practical for clinician to use those cements with the less sorption / solubility and more stable compression strength over time.

Thursday, June 08, 2017

3M Expands its Prevention Portfolio with New Varnish


 

ST. PAUL, Minn. – (June 1, 2017) – 3M, a leader in fluoride varnishes, has launched a new fast-releasing fluoride varnish in new flavors and a unit dose tray, to give clinicians another option for their patient’s needs. 3M’s new varnish complements 3M™ Vanish™ 5% Sodium Fluoride White Varnish, which has been the number one fluoride varnish on the market for ten years. 3M Vanish White Varnish is formulated to remain on teeth longer for more effective protection; with extended fluoride release, added tri-calcium phosphate and a durable coating.   Although longer fluoride contact is beneficial, some patients aren’t as compliant during their treatments, so 3M created 3M Fast Release Varnish.

3M Fast Release Varnish releases most of its fluoride in the first two hours, so dental professionals can deliver quick protection to patients who may not always follow their patient care instructions. With 22,600 ppm sodium fluoride, a virtually invisible smooth coating, and popular, fun flavors including caramel, strawberry and mint, 3M Fast Release Varnish is an excellent choice for patients who may require a shorter treatment time.

“My go to varnish has been 3M’s Vanish™ White Varnish because it’s so durable and the longer fluoride is in contact with the teeth, the more effective it is,” said Kelli Swanson Jaecks, RDH, MA. "However, some patients simply don’t like the taste or feel of fluoride treatments, and tend to brush off or remove their coating too soon. The new 3M™ Fast Release Varnish gives clinicians an alternative for patients just like these. It has a fast fluoride release and a nice smooth coating, so for certain patients, I know I’m giving them the quick protection they need.”

3M Oral Care promotes lifelong oral wellness through inventive solutions that help oral care professionals achieve greater clinical, professional and personal success. Learn more at 3M.com/OralCare. For more information on 3M Fast Release Varnish or 3M Vanish White Varnish, visit 3M.com/PreventiveCare.

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About 3M
At 3M, we apply science in collaborative ways to improve lives daily. With $30 billion in sales, our 90,000 employees connect with customers all around the world. Learn more about 3M’s creative solutions to the world’s problems at www.3M.com or on Twitter @3M or @3MNewsroom.
 
3M and Vanish are trademarks of 3M or 3M Deutschland GmbH. Used under license in Canada. © 3M 2017. All rights reserved. 

Wednesday, June 07, 2017

365 Days of Social Media Posts for Dentistry

From my friend Rachel Mele her new book 365 Days of Social Posts for Dentistry is now available for preorder. Books purchased before June 12th will be signed.

Click here to purchase

Tuesday, June 06, 2017

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index

Long time CCLAD user and it just works. Never thought to charge extra for it. MJ




Abstract

Aim

The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology.

Methods

Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients.

Results

A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$.

Conclusions

Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

Monday, June 05, 2017

The effect of a tooth/tongue gel and mouthwash regimen on morning oral malodour

A 3-week single-blind randomized clinical trial


Abstract

Aim

To compare the effects of a regimen consisting of a tooth/tongue gel, tongue cleaner and mouthwash with the effects of using standard fluoride dentifrice on the organoleptic oral malodour score (ORG) and volatile sulphur compounds (VSCs).

Materials and methods

A total, 66 non-dental students participated in a 3-week parallel, single-blind, randomized, controlled clinical trial. The test group used a tongue cleaner, a tooth/tongue gel and mouthwash containing amine fluoride/stannous fluoride and zinc lactate as oral malodour counteractive. The control group used a standard fluoride dentifrice. Measurements were taken in the morning at baseline, at days 1, 7 and 21. The primary outcome was the ORG score. The secondary outcome, the VSC measurement, was assessed using OralChroma™ (H2S, CH3SH, (CH3)2S) and Halimeter®. Tongue coating thickness and tongue discoloration were scored. At baseline and day 21, the participants’ self-perceptions were assessed.

Results

At day 1 for the ORG, H2S, CH3SH and Halimeter® readings, a significant decrease was observed in the test group. At day 21, the decrease in H2S and the Halimeter® outcomes were maintained for the test group, and a significant increase in tongue surface discoloration was observed. The test group evaluated their “morning breath upon awakening” as significantly better (P=.001) after 21 days.

Conclusion

A significant overnight effect on morning oral malodour was observed for most of the parameters in favour of the test group. At day 21, the effect of prolonged use was significant for H2S and the Halimeter® readings, although not for the primary ORG outcome parameter.

Friday, June 02, 2017

Digital transillumination in caries detection versus radiographic and clinical methods: an in-vivo study.

Dentomaxillofac Radiol. 2017 Apr;46(4):20160417. doi: 10.1259/dmfr.20160417. Epub 2017 Apr 6.

Abstract

OBJECTIVES:

This article aimed to evaluate: (a) the agreement between a near-infrared light transillumination device and clinical and radiographic examinations in caries lesion detection and (b) the reliability of images captured by the transillumination device.

METHODS:

Two calibrated examiners evaluated the caries status in premolars and molars on 52 randomly selected subjects by comparing the transillumination device with a clinical examination for the occlusal surfaces and by comparing the transillumination device with a radiographic examination (bitewing radiographs) for the approximal surfaces. Forty-eight trained dental hygienists evaluated and reevaluated 30 randomly selected images 1-month later.

RESULTS:

A high concordance between transillumination method and clinical examination (kappa = 0.99) was detected for occlusal caries lesions, while for approximal surfaces, the transillumination device identified a higher number of lesions with respect to bitewing (kappa = 0.91). At the dentinal level, the two methods identified the same number of caries lesions (kappa = 1), whereas more approximal lesions were recorded using the transillumination device in the enamel (kappa = 0.24). The intraexaminer reliability was substantial/almost perfect in 59.4% of the participants.

CONCLUSIONS:

The transillumination method showed a high concordance compared with traditional methods (clinical examination and bitewing radiographs). Caries detection reliability using the transillumination device images showed a high intraexaminer agreement. Transillumination showed to be a reliable method and as effective as traditional methods in caries detection.

Thursday, June 01, 2017

Alternative methods to visual and radiographic examinations for approximal caries detection.

J Oral Sci. 2017 May 19. doi: 10.2334/josnusd.16-0595. [Epub ahead of print]

Abstract

A shift in caries prevalence from occlusal surfaces to approximal surfaces has been demonstrated by epidemiological studies. Two recent meta-analyses evaluated the performance of visual examination and radiography for carious lesion detection, and reported low sensitivity but high specificity for early approximal caries detection. This suggests that the conventional methods have a higher risk of failing to detect approximal lesions. Consequently, in caries susceptible populations, there is a risk of progression of non-cavitated lesions to irreversible tooth destruction before the lesions are detected. This paper aims to review the performance of unconventional and novel methods for approximal caries detection. In vitro and in vivo studies identified through a MEDLINE search using keywords such as caries detection, approximal caries detection, light fluorescence and dental caries, and transillumination and dental caries were reviewed. The unconventional methods known to be used for approximal caries detection and included in this review are: cone beam computed tomography, fiber-optic trans-illumination, digital imaging fiber optic trans-illumination, near-infrared digital imaging transillumination, optical coherence tomography, laser fluorescence, ultrasound, and LED reflection and refraction.

Wednesday, May 31, 2017

Effects of Tooth Storage Media on Periodontal Ligament Preservation



Accepted manuscript online: Full publication history 


Abstract

Background / Aims

An easily available tooth storage medium is required to preserve a tooth after avulsion. Milk and Hank's balanced salt solution (HBSS) are recommended as tooth storage media, and egg white is also reported to be comparable with milk. The aim of the present study was to histologically and immunohistochemically evaluate the effect of different tooth storage media on the periodontal ligament (PDL) of extracted teeth.

Material and Methods

This experiment used HBSS, milk and egg white as tooth storage media. A total of ninety-six 6-week-old male Sprague-Dawley rats were used in these experiments. In each experiment, six rats were used for each medium and for the control group. Extracted rat molar teeth were immersed in these three different storage media for one-hour. In each medium, six samples (n=18) were fixed immediately, and the remaining samples (n= 54) were subcutaneously transplanted. In the control group (n=24), the extracted teeth were fixed or transplanted immediately after extraction. At day four, one week and two weeks after transplantation, the teeth were examined by radiographic, histological and immunohistochemical methods. The number of PDL cells in the storage media was also counted.

Results

Teeth immersed for one-hour in milk showed the thinnest PDL. Immunohistochemistry of periostin and CD68 labeling suggested degradation of the extracellular matrix in the PDL. In the media used for immersion, more PDL cells were observed in milk than in the other solutions. After transplantation, the HBSS and egg white groups maintained adequate thickness of PDLbut in the milk group, thinner PDL and ankylosis were observed.

Conclusion

Adequate thickness of PDL was maintained in the egg white group. Whereas, the milk group showed disturbance in the PDL, which may lead to ankylosis.

Tuesday, May 30, 2017

In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening.

Biomed Res Int. 2017;2017:7376261. doi: 10.1155/2017/7376261. Epub 2017 Apr 3.

Abstract

Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload.

Friday, May 26, 2017

Effect of coping thickness and background type on the masking ability of a zirconia ceramic



Abstract

Statement of problem

The masking ability of zirconia ceramics as copings is unclear.

Purpose

The purpose of this in vitro study was to evaluate the effect of coping thickness and background type on the masking ability of a zirconia ceramic and to determine zirconia coping thickness cut offs for masking the backgrounds investigated.

Material and methods

Thirty zirconia disks in 3 thickness groups of 0.4, 0.6, and 0.8 mm were placed on 9 backgrounds to measure CIELab color attributes using a spectrophotometer. The backgrounds included A1, A2, and A3.5 shade composite resin, A3 shade zirconia, nickel-chromium alloy, nonprecious gold-colored alloy, amalgam, black, and white. ΔE values were measured to determine color differences between the specimens on the A2 shade composite resin background and the same specimens on the other backgrounds. The color change (ΔE) values were compared with threshold values for acceptability (ΔE=5.5) and perceptibility (ΔE=2.6). Repeated measures ANOVA, the Bonferroni test, and 1-sample t tests were used to analyze data (α=.05).

Results

Mean ΔE values ranged between 1.44 and 7.88. The zirconia coping thickness, the background type, and their interaction affected the CIELab and ΔE values (P<.001).

Conclusions

To achieve ideal masking, the minimum thickness of a zirconia coping should be 0.4 mm for A1 and A3.5 shade composite resin, A3 shade zirconia, and nonprecious gold-colored alloy, 0.6 mm for amalgam, and 0.8 mm for nickel-chromium alloy.

Thursday, May 25, 2017

Comparison of access-hole filling materials for screw retained implant prostheses: 12-month in vivo study

International Journal of Implant Dentistry20173:19
DOI: 10.1186/s40729-017-0076-4
Received: 14 December 2016
Accepted: 22 April 2017
Published: 5 May 2017

Abstract

Background

Screw retained implant prostheses seem to be an efficient restorative method to prevent peri-implantitis caused by cement excess around the abutment. The drawback of the screw-retained prostheses is the difficulty to realize an efficient access-hole filling functionally and aesthetically. Up to now, few in vitro and in vivo studies were reported in the literature. The aim of this study was to evaluate clinical performances of two direct filling materials through a period of 12 months.

Methods

To pursue a previous in vitro evaluation, this in vivo 12 months prospective study followed up and compared the access-hole filling integrity of a modified 4-META (4-methacryloxyethyl trimellitate anhydride)/MMA-TBB (methyl methacrylate-tri-n-butyl borane) – based resin (M4M) and a photo-polymerizing nano-hybrid composite resin (CR).
Twenty-eight access-holes were filled with both materials respectively, then impressions and intra-oral photographs were taken at T = 0, T = 1 M (month), 3, 6, and 12 M. The access-hole surface measurement and the margin analysis (depth and angle) were carried out. The VAS (visual analogue scale) value on marginal discoloration and integrity at the baseline T = 0 and T = 12 M was recorded.

Results

The mean values of the surface areas changes from T = 1 to T = 12 M were 83.3 ± 11.5% for group CR and 77.1 ± 13.1% for group M4M, respectively. (Mann-Whitney test p < 0.05, p = 0.046). The mean marginal depth at T = 12 M for group CR were 141.2 ± 125.5 μm and 132.1 ± 107.8 μm for the group M4M, respectively. (Mann-Whitney test p > 0.05, p = 0.58). The mean values of the angle formed at the margin (T = 12 M) were for group CR 39.5 ± 19.4° and 28.2 ± 17.2° for group M4M, respectively (Mann-Whitney test p < 0.0001). The photographical analysis by VAS values showed no significant difference between CR and M4M groups (Mann-Whitney test p > 0.05, p = 0.848).

Conclusions

Based on intra- and extra-oral evaluations with the limitation, both CR and M4M combined with a ceramic primer are indicated as promising materials to fill the access-hole. Further long-term investigation is necessary to confirm this finding.

Wednesday, May 24, 2017

OraCoat® XyliGel® Assists Brace Wearers in Maintaining Good Oral Hygiene


Non-Acidic Soothing Gel Reduces New Plaque Buildup in Patients with Braces

Bellevue, WA (May 23, 2017) – OraCoat® XyliGel® helps reduce plaque and new cavities in brace wearers experiencing food and plaque buildup. The soothing gel acts as a buffer to neutralize harmful acids and works synergistically with a regular cleaning regimen to help preserve good oral hygiene while a patient wears braces.

Brace patients often face the development of tooth decay as a result of food and plaque forming between their brackets and wires. Although brushing and flossing are recommended to combat this issue, food particles may continue to linger, increasing the likelihood of new cavities.
By applying XyliGel between the brackets daily, brace wearers can help prevent new cavities. XyliGel helps to neutralize acids in the mouth with a pH of 7.4 and coats the mouth with xylitol to reduce new plaque formation. “For brace wearers, XyliGel is the perfect complement to regular cleaning,” stated Jeff Haley, OraHealth Corporation Founder, President, and Chief Scientist. “Consistent brushing and flossing after meals can eliminate some buildup; however, regular application of XyliGel greatly aids brace wearers in maintaining good oral hygiene.”

Effective for both daytime and nighttime use, XyliGel increases saliva production and coats the mouth and lips to help relieve dry mouth and reduce new plaque formation. The gel reduces plaque and acidity in the mouth.* XyliGel is the newest member of the OraCoat brand family of products which includes its flagship product, XyliMelts® oral adhering discs for dry mouth.

To order or obtain samples of XyliGel and for additional information on other OraCoat products, please visit www.oracoat.com.

*Documentation of these statements available upon request.


About OraCoat division of OraHealth Corporation
OraCoat®, a division of OraHealth Corporation, is the world leader in the breakthrough technology of “oral adhering discs” which slowly release ingredients in the mouth and are safe for use while sleeping. The OraCoat brand represents a family of products that solve oral care problems by coating the mouth with safe ingredients that become effective when they are slowly released. Our flagship product is XyliMelts® for dry mouth. XyliGel is a companion gel product for reducing plaque in very dry mouths. H-B12 Melts® discs help heal mouth sores. Other oral care solutions in the OraCoat family are planned. OraCoat’s innovative oral care solutions are backed by careful research based on medical science to ensure optimum performance and user safety.

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Tuesday, May 23, 2017

Tooth discoloration effects of calcium silicate based barrier materials used in revascularization and treatment with internal bleaching


Abstract

Background/purpose

Usage of barrier materials is an important step in revascularization procedure. One of the undesired properties of these barrier materials is to cause coronal tooth discoloration. The aim of this in vitro study was to evaluate the tooth discoloration induced by ProRoot MTA (PMTA), Biodentine, and MM-MTA, as well as the efficacy of internal bleaching on this discoloration.

Materials and methods

Forty-two maxillary incisor teeth were prepared. Triple antibiotic paste (TAP) was placed in the root canals and incubated for 3 weeks. After removing the TAP, blood embedded spongostans were inserted into the root canals, and PMTA, Biodentine, or MM-MTA was placed over them. The teeth were incubated for 4 weeks at 37 °C; then, the internal bleaching agent was sealed for one week. The tooth color was measured throughout the study and the color change values (ΔE) of each specimen were calculated, and the data was statistically analyzed using the one-way ANOVA and Tamhane's T2 tests.

Results

The TAP significantly decreased the luminosity of the teeth (p < 0.05); however, no significant differences were observed between the tooth discolorations induced by the PMTA, Biodentine, and MM-MTA (p > 0.05). The teeth in the Biodentine group were more whitened than those of the PMTA and MM-MTA groups (p < 0.05).

Conclusion

Although the PMTA, Biodentine, and MM-MTA caused similar color alterations in the teeth, more bleaching was observed on those teeth discolored using TAP + blood + Biodentine.

Monday, May 22, 2017

Influence of cement type and ceramic primer on retention of polymer-infiltrated ceramic crowns to a one-piece zirconia implant


Abstract


Statement of problem

The best procedure for cementing a restoration to zirconia implants has not yet been established.

Purpose

The purpose of this in vitro study was to measure the retention of polymer-infiltrated ceramic crowns to zirconia 1-piece implants using a wide range of cements. The effect of ceramic primer treatment on the retention force was also recorded. The retention results were correlated with the shear bond strength of the cement to zirconia and the indirect tensile strength of the cements to better understand the retention mechanism.

Material and methods

The retention test was performed using 100 polymer-infiltrated ceramic crowns (Vita Enamic) and zirconia implants (ceramic.implant CI) The crowns were cemented with either temporary cement (Harvard Implant semipermanent, Temp Bond), glass-ionomer cement (Ketac Cem), self-adhesive cement (Perma Cem 2.0, RelyX Unicem Automix 2, Panavia SA), or adhesive cement (Multilink Implant, Multilink Automix, Vita Adiva F-Cem, RelyX Ultimate, Panavia F 2.0, Panavia V5 or Panavia 21) (n=5). Additionally ceramic primer was applied on the intaglio crown surface and implant abutment before cementation for all adhesive cements (Multilink Implant, Multilink Automix: Monobond plus; RelyX Ultimate Scotchbond Universal; Vita Adiva F-Cem: Vita Adiva Zr-Prime; Panavia F2.0, Panavia V5: Clearfil Ceramic Primer) and 1 self-adhesive cement containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) (Panavia SA: Clearfil Ceramic Primer). Crown debond fracture patterns were recorded. Shear bond strength was determined for the respective cement groups to polished zirconia (n=6). The diametral tensile strength of the cements was measured (n=10). Statistical analysis was performed using 1-way or 2-way analysis of variance followed by the Fisher LSD test (α=.05) within each test parameter.

Results

Adhesive and self-adhesive resin cements had shear bond strength values of 0.0 to 5.3 MPa and revealed similar retention forces. Cements containing MDP demonstrated shear bond strength values above 5.3 MPa and displayed increased retention. The highest retention values were recorded for Panavia F 2.0 (318 ±28 N) and Panavia 21 (605 ±82 N). All other adhesive and self-adhesive resin cements attained retention values between 222 ±16 N (Multilink Automix) and 270 ±26 N (Panavia SA), which were significantly higher (P<.05) than glass-ionomer (Ketac Cem: 196 ±34 N) or temporary cement (Harvard Implant semipermanent: 43 ±6 N, Temp Bond: 127 ±13 N). Application of manufacturer-specific ceramic primer increased crown retention significantly only for Panavia SA.

Conclusions

Products containing MDP provided a high chemical bond to zirconia. Self-adhesive and adhesive resin cements with low chemical bonding capabilities to zirconia provided retention force values within a small range (220 to 290 N).

Friday, May 19, 2017

StellaLife Launches First Products


StellaLife®, an innovator in biotechnology products, announced the launch of a new line of products for oral pain management, accelerated healing, and long-term oral healthcare. The patent-pending VEGA® Oral Care system is formulated to improve dental postsurgical recovery and optimize oral systemic health. It is the first line of products launched by StellaLife. 

The VEGA Oral Care system consists of three natural products: a gel, a rinse, and a recovery kit that contains a spray in addition to the gel and rinse. The VEGA products accelerate healing and reduce pain, swelling, and bruising. They also contain anxiolytic properties to help reduce anxiety associated with dental procedures. The spray is for sublingual application, the gel is a topical application, and the rinse is a mouthwash that is antimicrobial and enhances wound healing. 

StellaLife VEGA Oral Care products contain sixteen active ingredients that are part of Homeopathic Pharmacopeia of the United States (HPUS). The products can be used after all dental surgical procedures, including bone and tissue grafting, extractions, implant placements, osseous surgery, biopsies, and dental nonsurgical procedures such as scaling and root planning, and quadrant dentistry. StellaLife products are manufactured in the United States, FDA registered, and follow the GMP guidelines.

“StellaLife’s mission is to improve people’s lives by helping to relieve pain, accelerate healing, and significantly reduce the need for opioids and steroids after dental procedures,” says StellaLife CEO Gennady Sirota. “Our products provide a safe, effective, and natural alternative to help deal with pain, accelerate healing, and promote optimum oral health.”

Dr. William Carter, a periodontist from Tennessee, has been working with the VEGA Oral Care products to heal his patients. Dr. Carter says: “StellaLife's VEGA Oral Care is the best product we have used for post-operative discomfort in the last 13 years.”

Dr. Jason Stoner, a periodontist from Ohio added, “My patients recovered more quickly, reported less pain, and on average required fewer narcotic pain medications when they used StellaLife. We have yet to uncover the limitations of this product.”  

StellaLife® is a biotechnology company that formulates oral health and pain management products that improve dental patients’ experience. VEGA® Oral Care solutions are clinically proven to accelerate healing and reduce pain, bruising and swelling after surgical and non-surgical procedures. In addition, its solutions deliver exceptional long-term oral health care. For more information, please visit www.stellalifehealing.com or call 800.828.7265.

Thursday, May 18, 2017

Cetylite® Launches New Cool Mint Flavor of Cetacaine® Topical Anesthetic Gel



Pennsauken, NJ (May 15, 2017) — Cetylite® Inc. recently designed a new flavor of one of its flagship products, Cetacaine® Topical Anesthetic Gel. Cetacaine will now feature a Cool Mint flavored gel, which will be available by mid-June. Indicated for anesthesia of accessible mucous membranes (except the eyes), Cetacaine is primarily used to control pain and ease discomfort at the application site.

Cetacaine comes available in three forms; liquid, spray, and gel. The liquid form is applied subgingivally into periodontal pockets, where the viscous drops are easily dispensed using the soft-tipped syringe. The spray form safely dispenses a mist of Cetacaine through the spray cannula to suppress the gag reflex when taking x-rays or impressions. Both the liquid and spray are banana flavored. The gel form, which currently comes in a strawberry flavor, is applied with a cotton swab or micro brush to the site where pain control is needed prior to injection and treatment. Cetacaine Gel reacts with body temperature to melt and absorb quickly into tissue, and distributes evenly and consistently.

“When it comes to products that are used in the operatory, it’s all about trust,” stated Kathy Perini, Marketing Manager of Cetylite. “When a clinician finds a product that they can rely upon and that allows their patients to be comfortable, they recognize the value and become very loyal. We know this because dentists and hygienists tell us their success stories all the time. We are proud to have earned their trust. Cetylite has been able to stand tall all these years by making products that stand the test of time.”

The triple-active formula of Cetacaine (Benzocaine, 14.0%, Butamben 2.0%, and Tetracaine HCL 2.0%) features a rapid onset of less than a minute, and 30-60 minute duration. While many clinicians assume
Cetacaine is comparable to OTC 20% Benzocaine, a blind study published in the peer reviewed publication, Anesthesiology Review, shows the Cetacaine formulation to be more effective than
Benzocaine alone.* Cetacaine Gel offers an outstanding choice for practices looking for an alternative to Benzocaine-only formulations. 

Cetacaine is a prescription topical, for professional use only. It is available through most dental and medical suppliers. For more information about Cetacaine and other Cetylite products and services, please visit www.cetylite.com.

For press inquiries or to schedule an interview with a Cetylite spokesperson, contact Kathy Perini at (856) 665-6111.

*Documentation of these statements available upon request.

About Cetylite Inc.
Founded in 1945 and headquartered Pennsauken, NJ, Cetylite Inc. is a third generation family owned and operated pharmaceutical manufacturer. Cetylite specializes in the manufacturing of topical anesthetics, infection control products, and auxiliary products that are widely used in the wholesale drug, medical, dental, and veterinary fields.



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