Contemporary Clinical Dentistry最新文献

Background: Effective communication is a skill for oral healthcare professionals, particularly while delivering bad news to patients. Structured approaches such as the SPIKES protocol can reduce patient anxiety, improve satisfaction, and support patient-centered care. While the SPIKES protocol is well recognized and increasingly practiced worldwide, in India, its awareness, practice, and training remain limited.

Aim: To assess the awareness, application, and training needs related to the SPIKES protocol among oral healthcare professionals in Indore, India.

Materials and methods: A descriptive and cross-sectional survey was conducted between April and June 2024 at the Government College of Dentistry, Indore. A total of 200 oral healthcare professionals completed a validated, structured questionnaire with 18 items divided into three domains: professional background, awareness and use of the SPIKES protocol, and training needs.

Results: Overall, 72% of participants agreed that following a structured protocol is essential when delivering bad news. Awareness of the SPIKES protocol was reported by only 38%, and among them, <20% had applied it in practice. A significant majority (84%) expressed the need for formal training in communication skills and the SPIKES protocol, with postgraduate students showing the highest demand (P < 0.05).

Conclusion: Awareness of the SPIKES protocol among oral healthcare professionals in India remains low, and its practice is also limited. At the same time, the strong demand for formal training highlights the need for immediate action. Incorporating SPIKES training modules, simulation-based teaching, and structured communication skill workshops into both undergraduate and postgraduate curricula are essential to ensure patient-centered cancer care.

Context: Saliva is rich in antioxidants, a natural defense system. Vitamin D, a steroid hormone and an antioxidant, is required in optimal quantities to maintain normal mineralization of teeth. The enzyme, glutathione peroxidase (GPx) is an antioxidant having an essential role in neutralizing free radicals. An imbalance in such salivary antioxidants causes an increase in reactive oxygen species, leading to oxidative stress that affects intracellular signals and promotes the growth of cariogenic bacteria.

Aim: The aim of this study was to evaluate and compare the levels of salivary Vitamin 25(OH)D and GPx in children with and without caries.

Settings and design: A cross-sectional study was conducted with 120 children, between 3 and 10 years of age.

Subjects and methods: Salivary samples of children with and without caries were collected to assess the levels of Vitamin D and GPx through commercially available enzyme-linked immunosorbent assay kits.

Statistical analysis used: Descriptive mean, along with Mann-Whitney test.

Results: Salivary Vitamin 25(OH) D levels were significantly higher in caries-free children, showing a strong inverse correlation with caries risk. This suggests a protective role of Vitamin D. Although the mean GPx levels were higher in children with caries, the difference was not statistically significant, indicating a possible oxidative stress response but limited diagnostic value. Overall, Vitamin D showed a more consistent association with caries status than GPx.

Conclusions: This study focused on individual antioxidant biomarkers, thus allowing applications for tailor made preventive strategies for early intervention of caries progression in pediatric population.

The use of cannabidiol (CBD) as an adjuvant in the treatment of trigeminal neuralgia (TN) and postherpetic neuropathy has shown beneficial effects in patients refractory to conventional treatments. This case study describes a 57-year-old patient diagnosed with TN in 2019, initially treated with low-power laser therapy and oxcarbazepine. In 2021, she developed vesicular-bullous lesions on the right side of the supraorbital region, accompanied by severe pain confirmed by positive serology for shingles. Following the diagnosis of postherpetic neuropathy, the drug dose was adjusted and combined with laser therapy. However, the pain remained significant and reduced quality of life. In 2023, treatment was started with CannaMeds CBD Full Spectrum - 3000 mg/30 ml + CannaMeds CBG Isolate 1500 mg/30 ml. After 15 days, the patient appeared pain-free, allowing the laser to be discontinued and the drug dose to be reduced. CBD is a treatment option for patients who do not respond to conventional treatments.

Background: Injectable platelet-rich fibrin (i-PRF) can be combined with bone graft materials to enhance its healing potential. Studies on improving the fibrin density and degradation properties of i-PRF-enriched bone grafts are lacking.

Aims and objectives: The aims and objectives of the study are to compare the fibrin porosity (density), solidification time, degradation properties, and cell counts of (i-PRF) bone blocks prepared using novel and traditional protocols.

Materials and methods: Venous blood (10 ml) was collected from six healthy volunteers to prepare the novel i-PRF in silica-coated plastic tubes (2000 g for 3 min) and traditional i-PRF in non-coated plain plastic tubes (700 g for 8 min). The i-PRF was mixed with xenograft to prepare the novel (NBB) or traditional bone blocks (TBB). The total solidification time and degradation properties of the bone blocks were analyzed. The density of the fibrin network in the bone blocks was compared using scanning electron microscopy images. The total and differential cell counts in the i-PRF were compared to those in whole blood.

Results: The NBBs had higher fibrin density (10-fold) and solidified faster (3-fold) than the TBBs (P < 0.001). The NBBs were more stable and resistant to degradation (>10 days), whereas the TBBs degraded within 4-6 days (average 4.67 days). The cell counts of both platelets and leukocytes in the novel and traditional i-PRF were significantly higher than the whole blood control (P < 0.001).

Conclusion: The novel protocol significantly enhanced the fibrin density, stability, and cell counts of the i-PRF bone blocks and shortened the solidification time.

Background: Due to demographic changes, the task of dental treatment for older patients is increasing. The aim of this study was to record polypharmacotherapy in elderly patients undergoing dental-prosthetic treatment. In addition, it was hypothesized that patients with removable dentures have a higher polypharmacy rate than patients with fixed dentures.

Methods: In a prospective and observational study, 103 patients aged 70 years and over were included. Age, gender, and the type of denture were recorded. Daily medication was charted using a questionnaire and patients' medication plan. The medication was recorded according to the anatomical-therapeutic-chemical classification system of the World Health Organization. In addition, a patient-related medication analysis was carried out.

Results: Of the 103 study participants, 59 were female and 44 were male. The average age was 80.7 years. Twenty-six patients were fitted with fixed restorations (PFR) and 77 patients with removable dentures (PRD). Polypharmacy (more than 5 medications taken) was equally common in both patient groups (62% in PFR and 61% in PRD; P = 0.964). The number of medicaments (4.8 ± 2.8 in PFR and 6 ± 4.3 in PRD; P = 0.318) and the number of medication groups (1.6 ± 0.9 in PFR and 2 ± 1 in PRD; P = 0.053) did not differ significantly. Considering the medication groups PRD group took anti-diabetic drugs significantly more frequent (4% in PFR and 25% in PRD; P = 0.021). Of the medications taken, 24% belonged to the group of anticoagulants/platelet inhibitors, 12% to the group of psychotropic/neurological drugs, 11% to antidiabetics, 1% to bisphosphonates/monoclonal antibodies, 1% to cytostatics, and 51% other medications. The patient-related analysis showed that 47% of the study participants took anticoagulants/platelet inhibitors, 25% psychotropic/neurological drugs, 19% anti-diabetics, 3% cytostatics/angiogenesis inhibitors, and 2% bisphosphonates/monoclonal antibodies. In addition, 93% of the patients took other medications, while only 6% of the study participants received no drug therapy.

Conclusion: On average, the majority of patients requiring prosthetic treatment were on polypharmacy. However, there was no difference between PFR and PRD patients regarding the number of medication groups and the number of medicaments. The dental treatment of elderly patients requires beside expertise in gerostomatology profound knowledge of pharmacotherapy in old age.

Among all the variables in Hanau's quint for achieving a bilaterally balanced occlusion, compensating curves are of paramount importance. Multiple methods for incorporating these curves in denture occlusion have been proposed. However, the equipment used to achieve this has certain limitations for inexperienced dental practitioners and technicians. This article discusses the use of a denture teeth arrangement jig with three-dimensional printed tooth positioning blocks, to subdue the challenges faced currently, and anticipates its use as an alternate method while arranging denture teeth. The purpose of the device is to precisely introduce the intended bilaterally symmetrical compensatory curves during denture teeth arrangement in less time.

Osteopoikilosis (OPK) is a rare benign bone dysplasia characterized by the presence of multiple radiodense patches scattered throughout the skeleton's trabecular bone. It presents as small well-demarcated bone lesions of variable sizes and of a sclerotic nature. OPK is a benign bone pathology that requires no treatment but monitoring and management of possible symptoms. This case highlights the incidental finding of an asymptomatic OPK in the mandible of a patient seeking orthodontic treatment; OPK manifestation in the mandible was rarely reported before. Radiologic and clinical diagnoses, along with the family history, confirmed the differential diagnosis of OPK. Such a differential diagnosis includes a range of serious conditions such as osteoblastic metastasis and tuberous sclerosis, making the correct diagnosis of OPK essential for overtreatment prevention. Treatment consisted of patient education, follow-up, and anti-inflammatory drugs in case of symptomatic flare-ups. This article reports on a case of OPK presenting lesions in the mandible as well as in other bones of the skeleton; such a manifestation of OPK in the cranium and specifically in the mandible is considered extremely rare.

Aim: This study evaluated the effect of intracanal medicaments and final irrigation techniques on resin cement penetration and the push-out bond strength of fiber posts.

Methodology: Ninety extracted mandibular premolars were allocated into three groups: no medicament (control), calcium hydroxide (CH), and triple antibiotic paste (TAP). CH and TAP groups were then subdivided based on final irrigation techniques: Conventional needle irrigation (CNI), sonic irrigation, passive ultrasonic irrigation, and XP-endo Finisher (XPF). Fiber posts were cemented with RelyX™ U200 resin cement. Confocal laser scanning microscopy was used to evaluate cement penetration, and push-out bond strength was measured. Data were analyzed using one-way and two-way ANOVA (P < 0.05).

Results: Compared to the control, both CH and TAP significantly decreased cement penetration and bond strength. XPF significantly enhanced these outcomes in CH-medicated canals. In TAP groups, all activation protocols improved adhesion results over CNI; however, the values remained significantly lower than those of the control. A significant interaction between medicament and irrigation protocol was observed only for maximum penetration depth.

Conclusion: Intracanal medicaments adversely affect fiber post bonding. Activated irrigation technique, notably with XPF, enhances bonding, especially following CH treatment. Bonding outcomes in TAP-treated canals remained inferior despite the use of activation procedures.

The esthetic and biomechanical rehabilitation of teeth with significant structural compromise remains a complex yet vital component of contemporary restorative and endodontic practice. Given their prominent role in facial appearance and psychosocial confidence, the loss of structural integrity in anterior teeth presents, with significant clinical challenges. Such teeth necessitate strategic internal reinforcement to withstand functional load and achieve a long-term success. This case series describes a customized approach for utilizing evidence-based reinforcing methods to restore severely damaged anterior teeth. The use of fiber-reinforced posts and anatomic/custom posts is emphasized to maximize even stress distribution and mimic the elasticity of the natural dentin. Furthermore, crown selection and other periodontal procedures, such as gingivectomy, were performed as required. The outcomes highlight the vital role of patient-specific treatment planning, biomechanical reinforcement, and appropriate material selection in achieving esthetically harmonious and long-term outcomes in complex anterior rehabilitations.