Dental Faculty

Clinical Updates

Latest Clinical Research

Highlights of selected new developments and trends in dental practice and research

IMPLANTSDentalImplants_ThinkstockPhotos-493611999

Bruxers and Failure Rates

Chrcanovic BR. et al., (2017) reviewed a retrospective study which investigated the link between awake and sleep bruxism and the risk of implant failure and then compared bruxers with non-bruxers.  3549 implants in 994 patients were reviewed.  There were 179 implants that were registered failures (46 at abutment connection and 86 during the first year).  Implant failure rates were 13% for bruxers and 4.6% for non-bruxers.

Conclusion:  The model revealed bruxism to be a statistically significant risk factor for implant failure.

Practical application:  Bruxing patients who undergo tooth replacement with implants should be treatment planned for optimal strength at the abutment fixture interface and provided with a splint.

Reference: Chrcanovic, B.R., Kisch, J., Albrektsson, T. and Wennerberg, A., 2016. Bruxism and dental implant failures: a multilevel mixed effects parametric survival analysis approach. Journal of Oral Rehabilitation43(11), pp.813-823.

PROSTHODONTICS

PROSTHODONTICS 1.1

Non-Vital Teeth as Abutments

Mizuno Y, et al., (2016) analysed the relationship between the type of edentulous spaces and tooth loss in RPD wearers.

102 consecutively treated patients with partial edentulism who were provided with RPD’s at a university-based clinic were evaluated to identify predictors of tooth loss.

Conclusion:  The presence of endodontically treated teeth at RPD placement was a significant predictor of future tooth loss.

Practical application: Avoid using endodontically treated teeth in critical retentive areas in partial denture design and plan for the possible failure of root treated teeth.

Reference: Mizuno, Y., Bryant, R. and Gonda, T., 2016. Predictors of Tooth Loss in Patients Wearing a Partial Removable Dental Prosthesis. The International Journal of Prosthodontics, 29(4), pp.399-402.

PERIODONTICS

cannabis

Cannabis Side Effects

Shariff JA. et al., (2017) examined the relationship between frequent recreational use of cannabis and periodontitis in adults.  Of the 1938 participants who were involved in the study, 26.8% were frequent recreational cannabis users.

Conclusion:  Bivariate analysis revealed a positive (harmful) association between frequent recreational cannabis and severe periodontitis in the entire sample as well as those who never used tobacco.

Practical application:  Educate patients who are in this high-risk category as to the implications of their habit. More frequent intervals for maintenance are advised.

Reference:  Shariff, J.A., Ahluwalia, K.P. and Papapanou, P.N., 2017.  Relationship between frequent recreational cannabis (marijuana and hashish) use and periodontitis in adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012. Journal of Periodontology, 88(3), pp.273-280.

DENTAL MATERIALS

posterior composites

Longevity of Posterior Composites

Alvanforoush N, et al., (2017) compared published success rates for posterior composite restorations placed between 1995-2005 and 2006-2016.  The restorations had to be in place for at least 24 months.

The overall survival rate for the earlier and later decades were 89.4% and 86.9% respectively.  Restorations failure due to secondary caries in the earlier decade was 29.5% and in the later decade 25.7%.

Material fractures of 28.8% and tooth fractures of 3.5% were reported in the earlier decade but in the later decade, material fracture increased to 39.1% and tooth fracture had increased to 23.8%.

Conclusion: It was speculated that the increase in composite and tooth fracture was due to placing larger composite resin restorations during the latter decade.

Practical application:  Understand and respect the limitations of direct composite in larger restorations and utilize capping cusps to protect remaining tooth structure.

Reference:  Alvanforoush, N., Palamara, J., Wong, R.H. and Burrow, M.F., 2017. Comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995–2005 and 2006–2016 periods. Australian Dental Journal, 62(2), pp.132-145.

ORAL MEDICINE

HPV

HPV Vaccine Essential

Human papillomavirus (HPV) infection is a distinct risk factor for oropharyngeal squamous cell carcinoma (OPSCC) and HPV 16 is associated with most HPV-OPSCC. The incidence rates of HPV-OPSCC have been increasing for the last 3 decades. Tobacco-related head and neck squamous cell carcinoma rates are decreasing worldwide (Javadi P. et al., 2017). Herrero R., et al., (2013) published results of first randomized controlled trial showing the benefit of HPV vaccine.

Conclusion: There was a 93% vaccine efficacy in reducing oral HPV infection at 4-year follow-up.

Practical application: Patients should be screened for currency of HPV vaccine and should be mandatory on the medical history forms.

References:

  1. Javadi, P., Sharma, A., Zahnd, W.E. and Jenkins, W.D., 2017. Evolving disparities in the epidemiology of oral cavity and oropharyngeal cancers. Cancer Causes & Control, 28(6), pp.635-645.
  2. Herrero, R., Quint, W., Hildesheim, A., Gonzalez, P., Struijk, L., Katki, H.A., Porras, C., Schiffman, M., Rodriguez, A.C., Solomon, D. and Jimenez, S., 2013. Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. PloS one, 8(7), p.e68329.

BUSINESS OF DENTISTRY

teledent

Tele-Dentistry Enhances Practices

Estai M. et al., (2016) explored Australian dental practitioners’ perceptions of the usefulness of tele-dentistry in improving dental practice and patient outcomes. Tele-dentistry is the remote provision of dental care, advice or treatment through the medium of information technology.  They designed a questionnaire assessing perceptions of dentists in four domains: usefulness of tele-dentistry for patients; usefulness of tele-dentistry for dental practice; capability of tele-dentistry to improve practice; and perceived concerns about the use of tele-dentistry.

Conclusion:  Most dentists agreed that tele-dentistry would improve dental practice through enhancing communication with peers, guidance and referral of new patients and improve patient management and increasing patient satisfaction. Concerns included with technical reliability, privacy, practice expenses, the cost of setting up tele-dentistry, surgery time and diagnostic accuracy.

Practical application:  Be mindful that dental technology is enhancing all aspects of dental practice. Those who do not embrace it will be left behind as patients are more and more technologically savvy and have expectations that are continually evolving.

Reference: Estai, M., Kruger, E. and Tennant, M., 2016. Perceptions of Australian dental practitioners about using telemedicine in dental practice. British Dental Journal, 220(1), p.25.

AESTHETIC DENTISTRY

toothmorph

Understanding Tooth Morphology

Mahn E. et al., (2017) evaluated different tooth shapes from different genders, matching them with traditional basic forms and proposed different hybrid shapes.  They also evaluated the percentage of correct gender identification of lay people, dentists and dental students.  Standardised digital photos were taken from 460 people and analyzed by 3 experts regarding genders and tooth forms: pure basic forms—oval (O), triangular (T), square (S) and rectangular (R); and combined hybrid forms—oval-rectangular (OR), triangular-rectangular (TR), triangular-oval (TO), square-oval with flat lateral incisors (SOF), and square-oval with scalloped lateral incisors (SOS).

Conclusion:  Pure forms were less prevalent in the population studied than hybrid ones and tooth gender selection among different evaluators was not significantly different.  The correlation of reported tooth shapes with specific genders was not reliably observed in natural smiles.  Pre-standardized pure tooth forms appeared less than hybrid ones, while the most frequently found in the population studied were TO, SOS and OR.

Practical application:  Tooth shapes should be selected according to patient wishes rather than by previously believed gender specific tooth shapes. Pure basic tooth forms should be complemented by adding of combination forms to more accurately portray those found in the patients’ dentition.  Listening to the expectations of the patient and utilizing digital diagnostic wax-ups will enhance final results.  Fabrication of excellent temporaries that will mimic the final restoration is encouraged.

Reference: Mahn, E., Walls, S., Jorquera, G., Valdés, A.M., Val, A. and Sampaio, C.S., 2017. Prevalence of tooth forms and their gender correlation. Journal of Esthetic and Restorative Dentistry.

ORTHODONTICS

mandibularadvancementspling

Changes to Occlusion with Use of Advancement Splints in Apnoea

Doff M.J.H. et al., (2017) selected 51 patients  randomized to oral appliance therapy and 52 patients to CPAP therapy for treating mild to moderate sleep apnoea.  At baseline and after a 2-year follow-up, study models in full occlusion were analysed with respect to relevant variables.

Conclusion: Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP.  In the oral appliance group, overbite and overjet decreased respectively.  Furthermore, a significantly larger anterior–posterior change in the occlusion in the oral appliance group compared to the CPAP group. Both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region.

Analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up. Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur.

Practical application:  The patient should be informed of possible consequences of oral appliance therapy and this should be included in the consent process.

Reference:  Doff, M.H.J., Finnema, K.J., Hoekema, A., Wijkstra, P.J., de Bont, L.G.M. and Stegenga, B., 2017. Long-term oral appliance therapy in obstructive sleep apnoea syndrome: a controlled study on dental side effects. Clinical Oral Investigations17(2), pp.475-482

Latest Clinical Articles

Get access to the latest clinical articles written by Dr David Penn.

The Bite Wafer Effect:

The Use of a Viscoelastic Appliance in the Management of Orthodontic Pain with Sequential Aligner Therapy

 

by David Penn, BDS, MBA

Published in
American Academy of Clear Aligners

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Current concepts in data capture for sequential aligner therapy

Dr. David Penn examines the accuracy and precision of the traditional versus digital impression techniques

by David Penn, BDS, MBA

Published in
Orthodontic Practice US

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