Dentistry Review最新文献

OBJECTIVES

The purpose of this case report is to outline a unique case of a 24-year-old male with difficult to control seizures and bilateral temporomandibular joint (TMJ) ankylosis including pre-operative workup, the perioperative medical and surgical management, and post-operative course.

METHODS

This patient has been followed by the Department of Oral and Maxillofacial Surgery for eight years and eventually developed bilateral TMJ ankylosis, for which bilateral custom joint replacement was recommended. Patient optimization for surgery required a multi-disciplinary approach in conjunction with neurology, anesthesiology, and the ICU/critical care teams.

RESULTS

This patient was able to successfully undergo surgery, consisting of bilateral custom TMJ replacement. This case offered a challenge in both peri-operative anti-epileptic management for seizure control as well as airway management with the use of an awake nasal fiberoptic intubation then converted to a tracheostomy.

CONCLUSIONS

Bilateral TMJ ankylosis is a rare and often difficult to manage condition. This report provides a unique case of a patient with difficult-to-control seizures and bilateral TMJ ankylosis as well as a discussion of management strategies and recommendations.

IMPLICATIONS

There is currently very literature in the OMS field of management recommendations for bilateral TMJ ankylosis and none in patients with a history of epilepsy or seizures. This report will offer the management strategies of these authors.

OBJECTIVES

The purpose of this study is to evaluate the preference of MAD appliances for patients diagnosed with OSA and bruxism using TAP 3 and modified ProSomnus IA oral appliances.

METHODS

Twelve patients diagnosed with OSA were referred for fabrication of a mandibular advancement device (MAD). At the initial appointment each patient was evaluated for signs and symptoms of bruxism. If bruxism was diagnosed the patient was informed of and given the choice to enroll in the research project. Once enrolled and informed consent obtained, digital scans of the patient were acquired using the Primescan (Dentsply Sirona) while in 50-60% of maximum protrusion. The ProSomnus IA was modified to have wings extended 2mm laterally to give similar range of lateral movement as the TAP 3. Patients were randomly chosen for which MAD would be delivered first. One MAD was delivered and used for one month. After one month the patient returned to the clinic and received the alternative MAD. At the final appointment, the patient was asked which device was preferred for long-term treatment.

RESULTS

8 patients enrolled in this study preferred the ProSomnus IA for treatment of OSA over the TAP 3 MAD. One patient was not able to tolerate either device and one dropped out of the study. The two patients who preferred the TAP 3 also used a CPAP simultaneously.

CONCLUSIONS

The modified ProSomnus IA was the preferred device for patients with OSA and bruxism. Patients who used the CPAP and MAD preferred the TAP 3. Patients selected the ProSomnus IA for the following reasons: the ability to open mouth with the IA, increased comfort, and ease of use. The IA was not chosen when the patient also used a CPAP due to discomfort from the wings of the IA on the buccal mucosa when used with a CPAP mask.

IMPLICATIONS

This project compared the preference between the Prosomnus IA and TAP3 appliance in patients that are diagnosed with obstructive sleep apnea and bruxism, potentially improving the decision making for clinicians when treating a patient with OSA and bruxism. Choosing the preferred device first will allow the patient to potentially receive successful treatment for OSA and bruxism in a more timely manner, increasing compliance, saving valuable clinic time, and preventing costly remakes.

OBJECTIVES

In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence.

METHODS

A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded and graded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates.

RESULTS

A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (OR: 3.2, 95% CI: 1.6, 6.1; p<.001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p=.004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p=.011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p<.001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p=.008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p=.005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p=.039) were associated with higher odds of intraoperative complication occurrence.

CONCLUSIONS

Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients.

IMPLICATIONS

An accurate appraisal of the risks associated with a procedure are necessary for patient consent concerning care. As we accumulate more information on complications, individualized risk-benefit assessments will become progressively meaningful for patients.

Objectives

Discuss how dental photography, also known as intra-oral photography, can affect patient acceptance of treatment plans.

Methods

A specific collection of available selection of literature was used to produce a reliable literature review. The articles selected were selected at most five years old. This review included a peer review to produce original research on the role of intra-oral photography in the treatment plan's acceptance. Many articles were not included due to being older than five years, literature reviews, or meta-analyses. The research concluded using concepts, keywords, and mesh terms.

Results

Some studies concluded that intra-oral photography can be effective in dental treatment, OHI, communication with the patient, exams, post-operative, and future restorative work. Research showed that intra-oral photography can increase patient care by increasing flossing and toothbrushing habits as well as correspond with decreased probing depths and bleeding on probing. Overall, research suggests that intra-oral photography can be beneficial when it comes to patient acceptance of treatment.

Conclusion

Even though dental photography is not implemented enough, the studies concluded that it could be effective in dental treatment, OHI, communication with the patient, exams, post-operative, and future restorative work. The review of the literature indicated that intra-oral photography could increase at home patient care by increasing flossing and toothbrushing habits and can correspond with decreased probing depths and bleeding on probing.3 Overall, the research suggests that intra-oral photography can be beneficial when it comes to patient acceptance of treatment plans. This research can be broadened by implementing intraoral photography in more clinics, providing more evidence on how it can improve a patient's oral health.

Implications

Intra-oral photos allow patients to visualize their oral conditions and smile with the same perception as the dentist or clinician.5 The research suggests that intra-oral photography can be beneficial when it comes to patient acceptance of treatment plans.

OBJECTIVES

This presentation will provide various sources of extracurricular activities in Augusta to the Dental College of Georgia's (DCG) students and staff. With providing outlets to relieve stress, the students and staff can hopefully boost their mental health and decrease chances of suicide.

METHODS

An electronic survey was sent to the students and staff of the Dental College asking various questions on how their time was spent prior to here, how it has been spent here, and activities they wish they knew were provided in Augusta. In addition, a few questions were asked to assess their mental health and their encounters of mental health prior and during their time at DCG.

RESULTS

The survey results used demonstrated what activities people liked to be a part of prior to their time at dental school as well as how that decreased at the school in part to not knowing alternatives provided in Augusta. Using these results, various extracurricular activities in Augusta were established and shown with photos to bring awareness, engagement and boost mental health.

CONCLUSIONS

Death by suicide occurs every 11 minutes and therefore, is the 10^th leading cause of death. Between ages 15 to 24 years old, it is the 2^nd leading cause of death. The average student at the Dental College of Georgia is about 24 years old. Transitioning from home to a new place like Augusta can be one of many reasons that someone's mental health declines. Augusta has many sources of extracurricular activities that can be used to better students and staff of DCG's mental health and therefore, prevent suicide.

IMPLICATIONS

With bringing awareness to Augusta's extracurricular activities, staff and students can engage, boost their mental health, and prevent death by suicide, while also excelling in their studies and care to patients.

OBJECTIVES

To educate and inform patients about Research on PRF therapy and Connective Tissue Grafting, gingival recession treatment, and Platelet-Rich Fibrin therapy so they can make informed decisions about their needed gingival procedures.

METHODS

For this literature review, the question was formulated to uncover new or less-known data regarding the restoration of gingival recession. Specifically, the question focused on comparing the outcomes of plateletrich fibrin (PRF) therapy to connective tissue grafting in the treatment of gingival recession. To locate relevant articles, the following MeSH terms were used: “gingiva, gingiva rejuvenation, gum graft, connective tissue graft, and PRF gingiva.” To ensure the specifics of the search, meta-analyses, literature reviews, systematic reviews, and articles published before 2018 were excluded.

RESULTS

Using PRF therapy is appealing because it comes from the patient's own body and might cause fewer problems. The studies reviewed demonstrate a spectrum of outcomes, with some suggesting equivalence between PRF and connective tissue grafting, while others emphasize that connective tissue grafting is still a very effective option. One is not simply seen as better than the other, but a preference for the patients.

CONCLUSIONS

Gingival recession management is a complex issue, with both connective tissue grafting and platelet-rich fibrin (PRF) therapy being treatment options. PRF therapy, which uses growth factors, is effective but depends on gingiva receding, patient-specific factors, and treatment methods.

IMPLICATIONS

Informing patients about platelet- rich fibrin therapy in comparison to connective gingival tissue grafting gives the patient the ability to decide what they believe is best of care.

OBJECTIVES

The aim of this survey study was to investigate and describe the use and effects of audiovisual distraction as a behavior management technique by pediatric dentists.

METHODS

An electronic survey was sent to the American Academy of Pediatric Dentistry (AAPD) member list via email inquiring about their use of televisions, iPads, and virtual reality playing audiovisuals as a behavior management technique during treatment. The survey queried providers about parent acceptance, patient individualization, clinical procedures and other behavior management techniques in which audiovisuals were used in conjunction, and the observed effects on patient behavior and quality of dentistry delivered.

RESULTS

Of the 326 respondents, 80% utilize TVs/iPads while only 4.4% utilize virtual reality in clinical practice. The greatest effect was observed in the patient age range of 6 to 8 years old. Observed effects included improved compliance, reduction in anxiety, decreased restlessness, and decreased attention to provider. Parents strongly accept the use of audiovisual distraction to complete treatment.

CONCLUSIONS

Audiovisual distraction is an effective behavior management technique employed widely by pediatric dentists in conjunction with other behavior management techniques for a variety of clinical procedures. Practitioners with less years of clinical experience are more likely to employ the use of audiovisual distraction in clinical practice.

IMPLICATIONS

Further use of audiovisual distraction could include potential improvements in the overall patient experience through reduction in anxiety during dental procedures and improved cooperation for pediatric patients.

OBJECTIVES

The purpose of this investigation was to compare the diversity of microbial communities at peri-implantitisversus stage III/IV periodontitis-affected sites using next-generation sequencing.

METHODS

Seven subgingival plaque specimens from each group of human donors diagnosed with peri-implantitis, stage III/IV periodontitis, or clinical gingival health (control group) were collected. Bacterial DNA was extracted, and the V4 region of the 16s rRNA gene was amplified. PCR-generated amplicons were sequenced, and operational taxonomic units (OTUs) were classified using the Silva database. Shannon Diversity Indices (SDIs) were estimated, and alpha diversity differences were tested using ANOVA. Bray-Curtis indices were computed to estimate beta diversity across groups, and Principal Coordinate Analysis (PCoA) ordination was completed. Significant variations in microbiome structure across groups was assessed using PERMANOVA. Genera that were differentially abundant across groups (absolute log2 fold change > 2) were identified.

RESULTS

OTUs clustered into three distinct groups based on sample source. PCoA results demonstrated statistically significant differences between clinical health and peri-implantitis (P-adjusted < 0.05), between clinical health and periodontitis (P-adjusted < 0.05), and between peri-implantitis and periodontitis (P-adjusted < 0.05). Biofilms derived from cases of clinical health exhibited a mean SDI of 2.46. By comparison, mean SDIs in the peri-implantitis and periodontitis groups amounted to 3.023 (Padjusted < 0.05) and 3.061 (P-adjusted < 0.05), respectively. Between the peri-implantitis and periodontitis groups, 8 OTUs exhibited statistically significant differential abundance. The genera Streptobacillus and Psychrobacter were dominant in the peri-implantitis group.

CONCLUSIONS

Microbial differences between the diseased environments could not be attributed to the unequivocal presence or absence of specific bacteria. Nonetheless, statistically significant differences in biofilm composition and complexity could be identified between peri-implantitis and stage III/IV periodontitis specimens.

IMPLICATIONS

An emerging hypothesis in periodontology and dental implantology posits that inflammatory destruction of tissue results not from the presence of one or a few key bacterial species. Rather, disease results from true polymicrobial activity characterized by accumulation of specific genes, and thus functions, within the biofilm. Moreover, the pathogenesis of peri-implantitis is known to involve the presence of titanium particles that influence the inflammatory response. The observed differences in biofilm diversity and composition in this investigation may reflect complex interactions involving titanium particles, host immune cells, and the biofilm at peri-implantitis sites.

OBJECTIVES

The purpose of this abstract is to describe how the use of phage therapy can be used to effectively target oral bacteria such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Enterococcus faecalis with minimal side effects to patients. These particular bacteria are important components in the process of caries formation, periodontal disease, and failed endodontic treatment.

METHODS

A search of Pubmed was conducted for peer-reviewed randomized control trials, clinical trials, and studies that were less than five years old. The keywords used to find relevant articles were: bacteria, oral bacteria, phage therapy, bacteriophage therapy, pathogenic bacteria, and dental bacteria.

RESULTS

The studies that were reviewed demonstrated phage therapy to be effective in reducing oral bacteria commonly responsible for dental caries, periodontal disease, and failed endodontic treatment. The first study showed the isolated phage, SMHBZ8, targeted S. mutans and reduced both biofilm formation and demineralization of enamel. The second study demonstrated the ability of a lysogenic bacteriophage, S1249, to be induced into the lytic cycle in human serum and effectively eliminate A. actinomycetemcomitans, a bacteria implicated in aggressive periodontal disease and known to be resistant to serum. The third study found a phage, PEf771, targeting E. faecalis in endodontically treated teeth with refractory periapical periodontitis was found to have greater substantivity and antibiotic properties than traditional medicaments used in root canal treatment.

CONCLUSIONS

These studies prove the viability of phage therapy as a treatment modality in targeting pathogens that contribute to major oral diseases. Benefits of phage therapy include low toxicity, high specificity, biofilm penetrating capabilities, and the ability to continuously replicate in the presence of target bacteria.

IMPLICATIONS

With more research to include human trials, phage therapy could prove to be a cost-effective alternative to conventional treatments in dentistry with fewer side effects to patients. Current treatment options for these oral diseases carry risks such as antibiotic resistance, staining, and toxicity. The ability of bacteriophage to target caries-causing bacteria such as S. mutans while sparing commensal bacteria is promising for preventive dentistry while the specificity and replicating abilities are desirable for eliminating periodontal and endodontic pathogens. The use of bacteriophage in dentistry could be adapted for delivery as a rinse, dentifrice, varnish, or targeted delivery system.

Essix trays are commonly used within dentistry for the temporary replacement of missing teeth following extraction of dental alveolar trauma. Typically, this procedure is performed easily with the use of an impression of existing arch, denture tooth, and Essix Tray material. This following report is unique due to the complexity of his existing maxillary dentition being restored with a combination of removable and fixed prosthodontics and the location of the fracture occurring within the esthetic zone. Furthermore, the patient's complex medical history and severe gag reflex added additional factors to the rehabilitation of this patient.

A 64-year-old Caucasian male presented to the General Practice Residency with fracture of his fixed partial denture (#9-11). Patient's maxillary arch was restored previously using FPD #6-8 and #9-11 with a Kennedy Class I removable partial denture. Opposing dentition was restored with all ceramic zirconia crowns. Secondary caries noted on fractured #11 deemed non-restorable and #9 fractured equigingival with fair prognosis for restoring via NSRCT, post, core and crown. History of Myocardial Infarction within past year and severe gag reflex. Impressions for this patient required the use of intravenous moderate procedural sedation. Consultation with PCP and cardiologist for medical clearance for moderate sedation were obtained and patient was appointed for impressions, records, and extraction of #9 and #11. Patient was offered plans including traditional denture fabrication, implant retained, or implant fixated prosthesis. Patient requested a temporary prosthesis to allow time to make decision on the final plans due to financial considerations.

This case report illustrates a unique application of the Essix Appliance for the temporization of this patient. Additionally, this case report shows a proof of concept for using Essix appliances in temporization of patients already restored with removable prosthesis. The final esthetics, function, and retention of the prosthesis were evaluated as adequate and acceptable to the patient. Pt was able to function with this temporary appliance for 3 months and was restored with an immediate maxillary denture. Patient is being seen for follow up to evaluate patient adaptation to the denture.