Dental Abstracts RSS feed: Current Issue. Information from around the globe is presented in this bimonthly publication featuring approximately 50 abstracts from key articles in dentistry. Dental Abstracts keeps dentists informed of developments and advances in general dentistry and its specialties in an easy-to-read, abstract format. Graphs, tables, and figures that have appeared in original articles are also included. This time-saving publication covers topics such as guided tissue regeneration, treatments for anterior single tooth implants, clinical evaluation of dentin bonding agents, and more. http://www.dentalabstracts.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Dental Abstracts0011-8486571January 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.dentalabstracts.com/article/PIIS0011848611006601/abstract?rss=yesEditorial Board10.1016/S0011-8486(11)00660-1Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-011http://www.dentalabstracts.com/article/PIIS0011848611006613/abstract?rss=yesTable of Contents10.1016/S0011-8486(11)00661-3Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-023http://www.dentalabstracts.com/article/PIIS0011848611006042/abstract?rss=yesThe discussion about new schools reminds me of the Wimpy character in Popeye who famously said, “I’ll gladly pay you Tuesday for a hamburger today.” Everyone knows that he never has, or will, pay on Tuesday. So, in Wimpy’s style, if I open a new school today, then on Tuesday, the number of credible academic faculty will increase dramatically, the number of people who can pay for or have somebody else pay for (i.e., the government) care will dramatically change, the number of people wanting comprehensive rather than episodic care will skyrocket, the graduates with $200,000 of debt will flock to underserved areas, and the return on investment for dental education will be adequate to maintain a highly qualified applicant pool. If we are evidence-based decision makers, the likelihood of being paid on Tuesday is a fantasy.In opposition to the increase in the number and size of dental schoolsJerold S. Goldberg10.1016/j.denabs.2011.11.001Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Commentary45http://www.dentalabstracts.com/article/PIIS0011848612000027/abstract?rss=yesEvidence-based dentistry is being widely encouraged, with whole systems developed to rate the hierarchy of evidence. One aspect that has been left out is time, which is especially important in evidentiary research dealing with dental materials and techniques. Often conclusions regarding dental materials and techniques are based on simple trends that are drawn from underpowered clinical trials, case reports, or in vitro research. However, speakers at various venues regularly present information as if it is proven doctrine. Three examples are offered to convey the importance of considering the effectiveness of materials over time.Taking time to gather evidence10.1016/j.denabs.2012.01.001Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Commentary56http://www.dentalabstracts.com/article/PIIS0011848611006078/abstract?rss=yesThe amount of material to be covered at the undergraduate level can be overwhelming for both the student who must learn it and the faculty who must prepare and teach it. In the current dental school curriculum, there are competing demands from various disciplines to cover more and more information while still integrating the knowledge into a cohesive and clinically relevant package. In former times, the amount that could be presented was limited by the speed at which students could transcribe the lecture. Assigned reading filled in the rest of the information. Today, using PowerPoint presentations allows the faculty member to highlight the important “take-home” messages in class, then provide copies of slides and still assign reading in the corresponding textbook. Because of all the demands on their time, students often cannot adequately review the background material and instead rely on memorizing the bulleted lists they have seen. Often they come to view anything other than these points as less important, which can result in a reduced appreciation for underlying mechanisms. Both students and faculty can be frustrated by this process as well as the mountain of material that is available to be learned. So, when faced with rare conditions such as pemphigus vulgaris, which develops in only one or two of a million patients, the question arises as to whether dentists should be expected to recognize such seemingly insignificant conditions.What is important?10.1016/j.denabs.2011.11.004Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Commentary67http://www.dentalabstracts.com/article/PIIS0011848611003670/abstract?rss=yesBetween patients and dentists, interpersonal relationships, particularly their communication aspects, are often as important to the patient as technical aspects of dental care. Good communication can reduce patient anxiety; increase patient satisfaction, motivation, and adherence to healthy behaviors; and lead to better oral health results. Inadequate or poor communication can create barriers to care and lead to undesirable outcomes. Communication is becoming even more important in light of the increasingly diverse US population that is also less educated, older, and more economically disadvantaged than previously. About 90 million US adults demonstrate health illiteracy, manifested by an impaired capacity to obtain and comprehend data on basic health care and services, thus inhibiting their ability to make wise health decisions. In addition, dental disease prevention and treatment are becoming more complex and harder to understand readily. The oral health risk factors, technologic advances, and care needs are challenging even for patients who use dental services regularly. For persons of low health literacy skills, communication is essential to avoid significant deficits. Dental practitioners must be able to communicate effectively with all patients and provide patient-centered, equitable, and high quality care to address national disparities in health. It is not uncommon for dentists to withhold information from patients if they perceive they are disinterested, could not understand, are making the dentist frustrated with communication efforts, or appear to prefer the dentist to make decisions about care. The techniques used by dentists to communicate with patients and their effectiveness were evaluated through a national survey.Techniques dentists use10.1016/j.denabs.2011.08.003Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Communication89http://www.dentalabstracts.com/article/PIIS0011848611003682/abstract?rss=yesIdeally, all staff members in a dental office should get along well and work together harmoniously while performing their specific tasks perfectly. Because this is unrealistic, it is important to recognize that both the right leadership and effective systems must be in place to have a smoothly working office, and even then conflict can develop. If the practice is poorly managed, conflict can cause a division among the troops, with stress, unacceptable customer service, and chaos in the office. Although the dentist may want to turn a blind eye and hope that it all works out, a better approach is to take steps to manage staff member conflict effectively.Staff conflict resolution10.1016/j.denabs.2011.08.004Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Communication910http://www.dentalabstracts.com/article/PIIS0011848611004894/abstract?rss=yesIn the case of Paul v Providence Health System-Oregon, 240 P.3d 1110 (Ore. Ct. App., 2010), the patient files of a dentist had been inside a briefcase securely locked overnight in the dentist’s car. The car was broken into and the briefcase was stolen. The unencrypted files included personal and medical information as well as clinical information, and the dentist immediately contacted all patients who were involved. A number of patients filed a class-action lawsuit against the dentist, claiming damages that they had suffered or would suffer in the form of financial injury involved in monitoring credit reports, notifying credit bureaus of fraud alerts, notifying the Social Security Administration and other governmental or law enforcement bodies, and possibly repairing identity theft damages. The plaintiffs claimed the dentist had a duty to safeguard the data, asserted the dentist had violated the Unlawful Trade Practices Act, and claimed he had misrepresented the business of selling services and goods because he knew that the transactions were not adequately protected by his data protection program. The outcome of the suit and its relevance to dental record management were discussed.Protecting patients’ private information10.1016/j.denabs.2011.09.004Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Confidentiality1011http://www.dentalabstracts.com/article/PIIS0011848611002615/abstract?rss=yesHaving patients fail to follow through with recommended treatments, not seek consultations, or miss scheduled appointments are part of the reality of dental practice. Contributory negligence is the term applied to the conduct that falls below the standard required for the patient to protect himself or herself from suffering physical harm. Most patients are cooperative and follow instructions. Should they fail to do so, any resulting negative effects are usually not clinically significant. However, some patients suffer harm while under the dentist’s care because of their own poor compliance. It is important to review the care provided for each patient and ensure that prudent risk management has been practiced.Contributory negligence10.1016/j.denabs.2011.05.007Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Ethics1112http://www.dentalabstracts.com/article/PIIS0011848611003694/abstract?rss=yesIf in the course of managing a postgraduate periodontics program in a dental school, a practitioner encounters patients who have been advised by a periodontist to undergo full-mouth periodontal surgery when the practitioner finds only minimal pocket depth that could respond to conservative treatment, the practitioner faces an ethical dilemma. Should the practitioner tell the patients that the other dentist has recommended treatment that may be unneeded? Should the practitioner have a resident provide care for patients that does not further his or her educational needs? The ethical solution to this situation was discussed.Overtreatment10.1016/j.denabs.2011.08.005Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Ethics1213http://www.dentalabstracts.com/article/PIIS0011848611003025/abstract?rss=yesThe way we make decisions changes with age at a fundamental physiological level. The brain approaches decision making and other tasks differently, and we need to understand it to be able to work within that context. Gregory Samanez-Larkin, co-director of the Scientific Research Network on Decision Neuroscience and Aging, focuses on brain systems involved in computing value when making financial decisions, which he finds are at the core of making decisions. He compared aids used by young people in their 20s and 30s and those in their 60s and older to make decisions regarding a set of risky or safe investment options. The brains of older adults were more likely to deviate from standard decision-making patterns when facing difficult choices than the brains of younger adults. This may graphically represent the observation that the elderly person may experience decision making as a chaotic and overwhelming act. It can also be more difficult for older adults to process information, with a tendency to become more easily distracted and unable to ignore irrelevant information. The focus of many older adults is on the present and on maximizing well-being, so that even reading a menu thoroughly may be seen as a pleasurable activity. Older adults are often resistant to change, however, and may end up ordering the same dish even after spending a lot of time studying the items on a menu.Decisions, decisions . . .10.1016/j.denabs.2011.05.048Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Extracts1313http://www.dentalabstracts.com/article/PIIS0011848611004948/abstract?rss=yesMany changes are taking place that affect the practice of dental hygiene. These include caring for underserved populations, changing workforce models, collaborating with other professionals, and recognizing oral health−overall health links. Periodontitis prevalence may be up to 50% greater than previously reported, according to the National Health and Nutrition Examination Survey (NHANES) III and National Health and Nutrition Examination Survey 2001–2004. In addition, the 2000 publication Oral Health in America: A Report of the Surgeon General states that good general health is not possible without good oral health. This has led to increased federal funding and many more publications exploring linkages between oral and overall health. The specific findings relative to periodontology were evaluated for their impact on how dental hygienists care for their patients.Periodontal issues10.1016/j.denabs.2011.09.009Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral-Systemic Health1414http://www.dentalabstracts.com/article/PIIS001184861100495X/abstract?rss=yesIn supportive periodontal care (SPC), the patient’s efforts to control periodontal infections and avoid re-infections are supplemented by professional therapeutic measures. As a result, there is an absence or significant reduction in clinical attachment loss and maintenance of a functional and aesthetic dentition. Long-term clinical benefit also depends on the availability of and access to care as well as the best use of available resources. Either periodontal specialists or general dentists can deliver SPC. Its efficiency is evaluated via economic analysis. Previous investigation found that delivering SPC through specialist periodontal practices provided greater periodontal stability and increased tooth survival compared with delivering it through general dental services. However, the cost was considerably higher with the specialists and was not adequately offset by the costs averted by preserving dentition. This study was confined to the United Kingdom, however, and may not adequately reflect the cost-effectiveness of SPC in other countries.Costs of supportive periodontal care10.1016/j.denabs.2011.09.010Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Dental Care Financing1516http://www.dentalabstracts.com/article/PIIS0011848611004961/abstract?rss=yesCost-effectiveness modeling is being used more often to provide estimates of long-term clinical and economic outcomes that are not obtained through clinical studies. Such analysis provides clear, standardized measurement of the value of health policies. Whether the outcomes of such analysis influence either public policy or implementation in dental practice is not yet clear. However, the Monitor Practice Programme (MPP) was developed to expand the generalizability of cost-effectiveness research by assessing the cost and effectiveness of a structured preventive dental program (the Caries Management System) compared with the standard dental care available in a private dental practice. The report noted 3-year efficacy results for the MPP, used these data to validate a model developed to assess MPP’s cost-effectiveness, and quantified the cost-effectiveness of the MPP and standard care, comparing them after 2 years, 3 years, and a theoretical patient lifetime.Cost-effectiveness analysis10.1016/j.denabs.2011.09.011Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Dental Care Financing1717http://www.dentalabstracts.com/article/PIIS0011848611002718/abstract?rss=yesThe negative effects of obstructive sleep apnea (OSA) are well known. Even mild levels show correlations with cardiovascular complications, excessive daytime sleepiness and fatigue, and a significantly altered quality of life. Continuous positive airway pressure (CPAP) therapy, although potentially of great benefit for patients with OSA, suffers from poor patient compliance. OSA surgery reduces the respiratory disturbance index by 50% and lowers events to fewer than 20 per hour for patients who do not tolerate CPAP therapy. Nothing has the ability to totally eliminate OSA, but maxillomandibular advancement (MMA) surgery is currently the most effective surgical therapy. Although this has been considered a procedure of last resort, evidence indicates that MMA should be thought of as the first and only surgical option for some patients. Specifically, patients with moderate-to-severe OSA with no significant pharyngeal redundancy, patients with significant maxillomandibular deficiency, young patients who need long-term OSA solutions, and patients who want the most effective single-stage approach should consider MMA as their first and best option. A review of the current status of MMA for OSA was presented.Maxillomandibular advancement surgery10.1016/j.denabs.2011.05.017Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Obstructive Sleep Apnea1819http://www.dentalabstracts.com/article/PIIS0011848611001506/abstract?rss=yesMany tribal societies in Africa, Asia, and South America have practiced body piercing for centuries, but the art has recently become popular among teenagers and young adults in Western societies. In addition, in some areas of the world, the practice has taken on cultural or religious significance. Common sites for body piercing include the ear lobes, nose, eyebrow, navel, nipple, and genitals. Pertinent to dental practice are piercings of the lips, cheeks, tongue, uvula, or combinations of these sites. Oral piercing is generally performed by unlicensed self-taught persons who may lack clinical and anatomic knowledge, who do not use anesthesia, and who do not observe infection control practices. As a result, complications are not uncommon, including hemorrhage, infection, edema, swelling, tenderness or pain, increased salivary flow, metal hypersensitivity reactions, and tooth trauma that can result in fracture. Blood-borne viruses or bacteria can gain access to the body through oral piercings, causing systemic disease. Generally, persons who have piercings are unaware of the serious complications that could develop. The awareness levels of adolescents and young South African adults regarding complications of oral piercing were measured and the types of complications noted.Oral piercing10.1016/j.denabs.2011.03.019Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Medicine1921http://www.dentalabstracts.com/article/PIIS0011848611001518/abstract?rss=yesTaste is often considered a minor sense because it provides information about only a few stimulus qualities. Considerably less medical and clinical research has been focused on taste because it is rarely significantly disrupted. However, it is a key sense in protecting human beings from consuming dangerous substances and in encouraging them to consume more nutritious substances. Disruptions may be rare but they can substantially alter both nutrition and quality of life. Often, the dental practitioner is the first clinician to see patients reporting a change in taste sensation. It is important to properly assess these patients and manage the problems presented.Taste disruption10.1016/j.denabs.2011.03.020Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Medicine2122http://www.dentalabstracts.com/article/PIIS001184861100152X/abstract?rss=yesTo safely perform dental extractions in patients taking oral anticoagulant therapy (OAT) requires establishing a balance between the risk of thromboembolic events and the risk of postoperative bleeding complications. The most recent recommendations are that patients’ OAT regimen be maintained and several postprocedural local hemostatic measures be instituted, such as gelatin sponges, oxidized cellulose, fibrin glue, sutures, and tranexamic acid, to control bleeding risks. Evidence thus far has consistently upheld this approach, but a large multicenter, prospective, case-control study was undertaken to confirm previous findings and validate the protocol.Dental extractions in anticoagulated patients10.1016/j.denabs.2011.03.021Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Surgery2324http://www.dentalabstracts.com/article/PIIS0011848611002755/abstract?rss=yesEach dental practitioner should consider the importance of communication, competence, and consent when planning oral surgery. Success or failure can depend on communication skills. In addition, it is vital to be able to objectively assess one’s own ability and competence when considering risk management for oral surgery procedures. Practitioners must be able to reflect on their own ability to execute the treatment plan that has been developed. If they are relatively inexperienced in a procedure, they have an obligation to inform patients and offer the choice of a referral to a more experienced colleague. Finally, patients must be provided with adequate information regarding the nature, purpose, and alternatives to a proposed treatment plan so as to provide informed consent. Included in this process is an explanation of the material risks and consequences of each approach. All of these aspects should be documented to minimize any risk that the patient will have cause to complain or claim negligence. Risk management is a process that begins with the preoperative assessment and continues through the various procedures performed.Risk management10.1016/j.denabs.2011.05.021Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Surgery2426http://www.dentalabstracts.com/article/PIIS0011848611002767/abstract?rss=yesPediatric dentists are especially interested in determining what children feel and how they will behave in the dental chair. Generally, they observe the child’s behavior and emotional status for cues as to how to best manage the child’s anxiety and/or pain and make the dental experience more pleasant. Children often have difficulty describing subjective experiences using verbal language but tend to do better matching internal states with pictorial expressions of emotions. Nonverbal self-report techniques have been used, including the visual analog scale, and have provided reliable and valid measurements of pain in pediatric dental patients. However, it is difficult to isolate pain from other emotional states with these tools, and the child may be inappropriately treated for the current situation. Art has proved useful in facilitating communication with children and offers a projective self-report of the child’s inner experience, especially with respect to stress and anxiety. Drawings are generally nondirective, require no right answers, and help identify feelings and desires that the child may not be consciously aware of or able to express otherwise. The applicability of children’s drawings as an indicator of level of distress was investigated in relation to standard assessment scales.Drawing measures anxiety10.1016/j.denabs.2011.05.022Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Pediatric Dentistry2628http://www.dentalabstracts.com/article/PIIS0011848611002779/abstract?rss=yesAs people are living longer and retaining more teeth into their later years, dentists are being called on increasingly to provide oral rehabilitation. Occlusal arrangements may be complex in these often partially dentate adults, presenting challenges for dental practitioners. The removable partial denture (RPD) is usually the simplest and most straightforward option for patients with multiple or extensive edentulous areas. RPDs are conservative of adjacent teeth and relatively inexpensive, but can suffer patient intolerance and create a higher probability of periodontitis and caries if they are not properly designed. The clinician is ethically and legally required to design appropriate devices and ensure the fabrication of a high-quality RPD. However, in a study in the United Kingdom, 53% of RPD prescriptions did not provide the dental laboratory with a denture design. Preparing a denture design requires that the dentist consider the saddle outline, support, retention, and connectors, among other things. Occlusal and cingulum rests are the primary source of support for tooth-borne and tooth and mucosa-borne dentures. These rests transfer the load from a partial denture through the teeth and periodontal ligament to the bone while providing indirect retention for the denture. Important features of these rests include their thickness, size, and shape. Tooth preparations made by general dental practitioners for occlusal and cingulum rest seats for cobalt-chromium RPDs were evaluated.Rest seat design10.1016/j.denabs.2011.05.023Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Prosthodontics2830http://www.dentalabstracts.com/article/PIIS0011848611002780/abstract?rss=yesThe success of prosthetic devices depends on the dimensional accuracy and detail reproduction of impressions and corresponding models that are used to create the restoration. Impressions are obtained to provide a dimensionally stable “negative” that will serve as a cast mold. Impression materials must be able to reproduce the static oral structures accurately if an optimum reproduction of preparation margins is to be obtained. This ability varies depending on the material chosen. The marginal precision averages 50 μm on dental restorations and represents the sum of all relative and absolute errors incurred in the fabrication process. For each stage, the error rate must be minimal to reduce the cumulative effect. Conventional impressions are still required to transport information from the dentist to the dental laboratory where fabrication is done. Eventually, digital impressions will be sent to the laboratory and no impression will be needed. Until that time, good impression materials are essential to maintain a faithful representation in restorations. A detailed overview of all appropriate dental impression materials for fixed prosthodontics was offered, along with the clinical implications of their properties.Impression materials10.1016/j.denabs.2011.05.024Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Prosthodontics3031http://www.dentalabstracts.com/article/PIIS0011848610005066/abstract?rss=yesEndodontically treated teeth have a history of reduced resistance to fracture and diminished strength as compared with vital untreated teeth. Various factors contribute to this weakness including loss of structural integrity, stress from the various procedures that were performed, and inappropriate selection of tooth abutments for prosthetic elements. Restoring endodontically treated teeth should be designed to increase tooth fracture resistance, often with posts to support and reinforce the remaining tooth structure. The relevant published data on the fracture resistance of teeth restored with post-retained restorations were reviewed.Fracture resistance for post-retained restorations10.1016/j.denabs.2010.10.026Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry3233http://www.dentalabstracts.com/article/PIIS0011848610003936/abstract?rss=yesCrown-lengthening procedures are often applied when caries or fractures are extensive and are located subgingivally. With this therapy, dentists can expose the solid tooth structure and proceed with the restoration efforts. The goals, basic surgical principles, wound healing linked to crown-lengthening procedures, the outcomes of the therapy, and the results in a clinical case observed for 8 years were reported. Both clinical and radiographic studies and literature reviews were included in the information search. Only publications relating surgical exposure of natural dentition to restorative options, aesthetic concerns, or both were included.Crown lengthening10.1016/j.denabs.2010.08.023Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry3335http://www.dentalabstracts.com/article/PIIS0011848610005625/abstract?rss=yesThe most important factors in achieving successful resin-based composite (RBC) restorations are good bonding to tooth structure and adequate resin polymerization. Optimal polymerization relies on the clinical efficiency of the light-curing unit. The wavelength of the emitted light, type of photoinitiator, bulb intensity, exposure time, distance and angle of the light tip from the composite surface, type of RBC, and shade of resin composite all contribute to achieving an efficient cure.Light-curing of resin-based composites10.1016/j.denabs.2010.12.022Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry3537http://www.dentalabstracts.com/article/PIIS0011848610005637/abstract?rss=yesDentists can be called upon to perform esthetic treatment of a single discolored anterior tooth. The most conservative approach is generally bleaching, followed by laminates that can mask or reduce the discoloration while maintaining the tooth structure. Ceramic laminate veneers allow the tooth to behave similar to a natural, unrestored tooth with respect to strain and stress transference. Feldspathic ceramic laminate was used for a young woman with a dark maxillary central incisor ().Porcelain laminate veneer10.1016/j.denabs.2010.12.023Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry3739http://www.dentalabstracts.com/article/PIIS0011848610005649/abstract?rss=yesIt has been recommended that one should leave carious tissue on the axial floor of deep lesions rather than perform vigorous excavation because there is less pulpal damage, caries is halted, and the short-term longevity of the restoration is acceptable. However, questions arise about the long-term survival of restorations placed after incomplete caries removal. Leaving a layer of carious dentin may compromise the strength of the restoration. Higher bond strengths are noted with restoration materials bonded to sound rather than carious dentin, and also carious dentin is softer and has a lower Young’s modulus than sound dentin. Thus, fracture strength may be compromised when soft carious tissue is left in the cavity before the restoration is placed.Incomplete versus complete caries excavation10.1016/j.denabs.2010.12.024Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry3941http://www.dentalabstracts.com/article/PIIS0011848610005650/abstract?rss=yesPrimary snoring is defined as snoring associated with changes in the caliber of the upper airway, causing reduced flow and increased airway resistance but no clinical symptoms or sleep disruption. Snoring should be diminished by displacing the tongue anteriorly, which tends to compensate for inadequate activity of the pharyngeal opening muscles. Use of tongue-retaining devices may reduce the time of loud snoring that occurs during sleep. Mandibular position can also influence the patency of the upper airway. This may be related to jaw opening associated with the posterior movement of the jaw angle, which compromises oropharyngeal airway diameter. Upper airway resistance is significantly lower during nasal breathing than mouth breathing, so pure nasal breathing and complete closure of the mouth are characteristic of normal breathing at rest. The switch to oral breathing during sleep increases nasal resistance, compromises the airway, and increases breathing effort. The tongue-repositioning maneuver (TRM) places the tongue in a position where it contacts the soft palate using intraoral negative pressure formation that promotes nasal breathing. A membrane funnel shield is used as a pressure-indicating device, so that the subjects can see how negative intraoral pressure forms during and after deglutition. The TRM leads to an anterior and superior intraoral tongue position, contributing to continued jaw closure. Exercises using the TRM may benefit patients with snoring and breathing problems. The effect of the TRM treatment concept on primary breathing was investigated.Tongue-repositioning maneuver10.1016/j.denabs.2010.12.025Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Sleep Disorders4141http://www.dentalabstracts.com/article/PIIS0011848611002822/abstract?rss=yesThe use of endosseous oral implants to support mandibular dentures is considered the preferred treatment for edentulous patients with retention problems related to conventional mandibular dentures. There is no age restriction as to when oral implants can be inserted to support overdentures, as this is a good treatment option for all ages. Implant-supported prosthodontic rehabilitation of functional and esthetic oral problems is being used more and more often with very favorable results in independent subjects who can perform the required level of oral self-care. However, for patients who have become dependent on others for daily oral health care, these restorations represent a challenge. Specific oral care is not always available for patients with implant-supported dentures, or in some instances, the caregivers may not be aware, educated, or practiced in the specific care needed. Dental hygienists, dentists, care providers, volunteer aides, and healthcare insurance companies need to be aware of the growing demand for specific oral health care for patients with implant-supported (partial) dentures. Three cases are presented that illustrate the required care and aftercare needed. Recommendations for resolving implant-related oral problems are offered.Oral implant care for dependent persons10.1016/j.denabs.2011.05.028Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Special Needs4244http://www.dentalabstracts.com/article/PIIS0011848610005078/abstract?rss=yesIt can be difficult to diagnose and manage temporomandibular disorders (TMDs). As with other chronic illnesses, the diagnosis will significantly affect how individuals think about themselves and how their condition influences daily life. Obtaining a diagnosis and an appropriate management plan can be hindered by various factors. The effects of seeking diagnosis and treatment for TMDs were evaluated in a qualitative study.Seeking a diagnosis10.1016/j.denabs.2010.10.027Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Temporomandibular Disorders4445http://www.dentalabstracts.com/article/PIIS0011848611002834/abstract?rss=yesDental offices used to be “drill and fill” practices, with little demand for elective dentistry or cosmetic procedures other than for the rich and famous. Orthodontics was generally limited to children. At present, dentistry is dealing with an explosion of technology and services to provide to consumers. The general public demands many of these options and can pay for them. Has the definition of what constitutes “ideal treatment” been lost? Presenting the ideal treatment to patients educates them, increases their awareness about the recommended dentistry, and establishes a way to prioritize recommended procedures. Patients receive the “big picture” so they know what it will take to achieve optimal oral health. In this presentation, they can also be informed about services that are important to their overall well-being but not mandatory for good oral health. Often these are cosmetic and implant options. The dentist must determine whether the patient should be told about these as part of the discussion of the ideal plan or whether they should be presented separately.Ideal treatment10.1016/j.denabs.2011.05.029Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Treatment Planning4545http://www.dentalabstracts.com/article/PIIS0011848611002901/abstract?rss=yesMillions of denture patients live in the United States and many use denture adhesives. Because zinc is an ingredient in denture adhesives, patients may inadvertently ingest more than the recommended daily allowance of zinc (). The literature indicates that the ingestion of excess zinc can induce copper deficiency and result in neurological problems. GlaxoSmithKline has informed all healthcare providers that their denture adhesives will no longer contain zinc, but zinc is still in the other manufacturers’ products. Dentists must understand how the excessive use of zinc-containing denture adhesives can cause bone marrow suppression and polyneuropathy, with numbness and paresthesia of the extremities, loss of balance, and walking problems. The adverse systemic effects of prolonged, excessive ingestion of zinc from denture adhesives were documented.Denture adhesive zinc10.1016/j.denabs.2011.05.036Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Medicine4647http://www.dentalabstracts.com/article/PIIS0011848611002913/abstract?rss=yesRadiotherapy is an established treatment method for managing malignant disease of the head and neck. This modality targets all cells with a high turnover rate, regardless of whether they are malignant or normal tissues. The key to achieving a cure is to balance the eradication of tumor cells with the avoidance of further patient debilitation. The adverse effects on normal tissue limit the dose and delivery rate of radiotherapy. Osteoradionecrosis (ORN) is one of the most serious complications of radiotherapy. ORN is defined as an area of exposed devitalized irradiated bone that does not heal within 3 to 6 months with no local neoplastic disease. ORN is difficult to treat and is often associated with a poor outcome and deformity. ORN can be spontaneous, caused by periodontal and apical disease, can result from trauma induced by dentures, or can develop after surgery or tooth extraction—with the last being the most common initiating factor. ORN’s reported incidence ranges from 2% to 18% after tooth extraction in irradiated patients. Efforts to prevent this complication include antibiotic prophylaxis before extractions, hyperbaric oxygen (HBO) before extractions, and pentoxifylline and tocopherol weeks before extractions. Intraoperatively, alveoloplasty, primary closure, and limited periosteal trauma during extraction are critical in avoiding ORN. Also, the number of teeth extracted in a single session is limited. The use of low-adrenaline local anesthesia or the avoidance of certain local anesthetics can also diminish the risk of ORN. The exact incidence of ORN after postirradiation extraction and the most effective method of reducing this incidence were sought.Osteoradionecrosis in irradiated patients10.1016/j.denabs.2011.05.037Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral Surgery4748http://www.dentalabstracts.com/article/PIIS0011848611001701/abstract?rss=yesAfter nonsurgical root canal treatment (NSRCT), between 59% and 73.5% of teeth that suffer a major untoward event are extracted within 2 to 8 years. These untoward events are usually caused by endodontic, prosthetic, or periodontal failure—all dental-related reasons. However, it is possible that systemic disease may increase the risk of tooth extraction after NSRCT. A large-scale prospective study of teeth having NSRCT was undertaken to determine the influence systemic disease has on the risk of tooth extraction after NSRCT.Tooth extraction after root canal therapy10.1016/j.denabs.2011.03.039Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Oral-Systemic Linkages4950http://www.dentalabstracts.com/article/PIIS0011848611002937/abstract?rss=yesSuccessful orthodontic treatment depends on the establishment of a good relationship between the patient and the orthodontist. This begins with the consultation and treatment planning stages and continues throughout the process. Both patients and parents are more informed about orthodontics at present than in previous times. Extractions are done to provide space to accommodate a crowded dentition or to achieve orthodontic camouflage. The range of extraction frequencies between practitioners varies considerably, although generally, the frequency is diminishing. During informed consent, patients are offered all alternative treatments and may seek further information on the Internet to help them in choosing among the options, such as extraction or nonextraction. The quality of health information available on the Internet is problematic. To help users discriminate between sites, several organizations have developed methods and tools to assess and rate the quality of the health information presented. The LIDA instrument is a validated method of assessing the design and content of healthcare Web sites, measuring accessibility, usability, and reliability. Readability has been assessed using the Flesch reading ease score. A study was conducted to analyze the quality of information available on the Internet for persons interested in orthodontic extractions.Internet information10.1016/j.denabs.2011.05.039Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Orthodontics5051http://www.dentalabstracts.com/article/PIIS0011848611001749/abstract?rss=yesIn generalized aggressive periodontitis (GAgP), there is severe destruction of the supporting structures of the teeth that can cause edentulism early in life. This is a relatively rare disorder and little studied. Treatment approaches begin with a cause-related treatment phase aimed at reducing and/or eliminating pathogenic microorganisms. Systemic antimicrobials may also prove beneficial. A 7-day adjunctive course of systemic metronidazole and amoxicillin significantly improved the short-term clinical outcomes in patients with GAgP who underwent nonsurgical debridement. However, in clinical practice, antimicrobials are more likely to be used for retreatment than for initial therapy. An investigation was undertaken to determine whether retreatment with adjunctive antimicrobials achieves the same benefit in patients who received instrumentation alone (placebo group), as was seen in patients receiving antimicrobials initially (test group).Antimicrobials for aggressive periodontitis10.1016/j.denabs.2011.03.043Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Periodontal Disease5151http://www.dentalabstracts.com/article/PIIS0011848611002950/abstract?rss=yesCaries remains a widespread public health problem and is mainly treated with restorative options, although the problem is preventable. At present, there are many aids to protect dental health but also many harmful influences, such as sugary snacks and drinks. A correlation between caries incidence and sugar consumption has been documented repeatedly, although fluoride use can weaken this relationship. The use of xylitol-containing products has also been strongly associated with a significant reduction in caries incidence and with lesion remineralization in young children, school-aged children, and mothers. Toothbrushing twice daily is known to promote better dental health as well. To assess the role of oral health-related behaviors on adults’ dental health, the relationship between the frequency of consuming sugar- and xylitol-containing products, of toothbrushing, and of the use of fluoride toothpaste with adults’ dental health was investigated.Sugar, xylitol, toothbrushing, and fluoride10.1016/j.denabs.2011.05.041Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Preventive Dentistry5252http://www.dentalabstracts.com/article/PIIS0011848610005819/abstract?rss=yesDental caries lesions progress through various stages based on a continual imbalance between pathologic and protective factors. The process involves the dissolution of apatite crystals and the loss of calcium, phosphate, and other ions from the tooth, termed demineralization. Modern dentistry hopes to manage noncavitated caries lesions noninvasively by remineralizing these sites, preventing disease progression, and improving esthetics, strength, and function. Remineralization is defined as the process wherein calcium and phosphate ions are supplied from a source external to the tooth, promoting ion deposits into crystal voids (any accessible spaces in a crystal caused by ion loss) in demineralized enamel, producing a net gain in mineral content. Saliva produces a small amount of remineralization over a long time and generally only affects the surface layer of lesions. New remineralization systems are needed to effectively halt the progression of lesions and achieve their resolution. Fluoride promotes net remineralization when calcium and phosphate ions are readily available. With sufficient amounts of these ions and the fluoride, substantial remineralization of enamel and dentin caries lesions can be achieved. The ideal remineralization system should supply stabilized bioavailable calcium, phosphate, and fluoride ions that promote subsurface mineral gains. Various approaches were discussed.Calcium phosphate-based systems10.1016/j.denabs.2010.12.041Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Remineralization5354http://www.dentalabstracts.com/article/PIIS0011848611001774/abstract?rss=yesThe acid-etch technique is the most effective method for reliable and durable bonding to enamel. Self-etch adhesives have been developed to address demands for simplicity, rapid use, and low technique sensitivity. Mild and ultra-mild self-etch adhesives are significantly less acidic than other one-step adhesives and have a prolonged shelf life. However, composite restorations bonded with these milder varieties tend to have margin adaptation problems at the enamel surface, which have been attributed to interference caused by bur debris smeared across the enamel during cavity preparation. Various surface preparation methods were evaluated through high-resolution transmission electron microscopy (TEM) for their effects on the interfacial structure of an ultra-mild self-etch adhesive bonded to enamel.Mild self-etch adhesives10.1016/j.denabs.2011.03.046Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Restorative Dentistry5454http://www.dentalabstracts.com/article/PIIS0011848610005820/abstract?rss=yesSealant manufacturers recommend that teeth be cleaned before acid etching and placement of a sealant. However, the method of cleaning is not always specified in the instructions for use. Whether sealant retention is equally good after toothbrushing and handpiece prophylaxis was investigated through a review of randomized controlled trials or systematic reviews on the issue. Direct evidence from two clinical trials found no difference in sealant retention between surfaces cleaned mechanically using pumice or prophylaxis paste and those to which an air-water syringe or dry toothbrushing was applied. Indirect evidence in 10 studies showed that toothbrush prophylaxis had sealant retention values of greater than or equal to those achieved with handpiece prophylaxis. In school-based dental sealant programs, it is much cheaper to use toothbrushing to clean tooth surfaces before applying the sealant than using handpiece prophylaxis. This finding that the retention of the sealant is the same or better along with the toothbrushing can produce savings in material, equipment, and personnel.Cleaning tooth surfaces before sealing10.1016/j.denabs.2010.12.042Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Sealants5555http://www.dentalabstracts.com/article/PIIS0011848610005832/abstract?rss=yesThe sleep-related breathing disorder obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by disruptive snoring and repeated partial or complete upper airway obstructions. The severity is measured using the apnea–hypopnea index (AHI) and can be mild (AHI: 5 to 15), moderate (AHI: 15 to 30), or severe (AHI: >30). Excessive sleepiness, increased risk of accidents, and impaired quality of life are common, along with an increased risk for ischemic heart disease, congestive heart failure, and stroke. Treatment usually involves a continuous positive airway pressure (CPAP) device, but compliance is low and patients often prefer the less-intrusive oral appliances that reposition the mandible forward and downward. Mild and moderate OSAHS might respond to oral appliance therapy, but severe OSAHS is best addressed with CPAP. The side effects of oral appliances are usually transient and mild, such as tooth pain, occlusal changes in the morning, dry mouth, excessive salivation, gingival irritation, temporomandibular joint (TMJ) pain and sounds, and myofascial pain. Cephalometry is used to assess craniofacial changes that can occur with long-term oral appliance use. Usually these involve a significant decrease in overjet and overbite, retroclination of the maxillary incisors, proclination of the lower incisors, and a more downward and forward mandibular position. The cephalometric analysis of changes in craniofacial morphology occurring over 2 years of oral appliance treatment was compared with changes in a CPAP group. The occurrence of these changes and the degree of mandibular protrusion during therapy with oral appliances were also noted.Craniofacial changes with oral appliance therapy10.1016/j.denabs.2010.12.043Dental Abstracts 57, 1 (2012)2012-01-01Dental Abstracts2012-01-01571S0011-8486(11)X0008-0Sleep Apnea5556