Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

Mandibular staple implants were historically used to manage mandibular fractures and retain overdentures but are associated with long-term complications. This case report describes an 85-yearold patient with chronic infection and bone loss related to a decades-old mandibular staple implant. Digital planning facilitated safe implant removal, grafting, and reconstruction using narrow-diameter endosseous implants. The article highlights surgical challenges, risk mitigation, and successful functional rehabilitation in a severely atrophic mandible.

One of the toughest challenges in esthetic dentistry is to match the shade of full-coverage crowns and resin-bonded laminate veneers on maxillary incisors. This is particularly difficult when dealing with dissimilar underlying substrates, varying levels of tooth discoloration, and different amounts of sound structure. This clinical report describes an alternative approach for matching the color shade in the anterior area to overcome substrate-related esthetic limitations. To facilitate the tooth being crowned, a core was made from high-opacity lithium-disilicate ceramic, with the shape and shade of the adjacent teeth prepared for veneers. Four veneers were fabricated from high-translucency lithiumdisilicate ceramic and bonded to the natural teeth and the lithium-disilicate core using the same resinbased composite cement to achieve a uniform shade on all restored teeth. A digital workflow was applied to design and manufacture the restorations. This case report demonstrates that the combination of a medium- or high-opacity lithium-disilicate substructure and thin veneers, supported by a digital planning workflow, can provide a viable solution for anterior cases with varying substrate discoloration and restoration thickness.

Impacted maxillary canines present significant esthetic, functional, and surgical challenges for dental clinicians. This article introduces a CBCT-guided, 3D-assisted diagnostic and treatment protocol supported by a novel, clinically driven classification system. Three management strategies are outlined: extraction with implant placement, implant placement through the impacted canine, and prosthetic alternatives when surgical risks are excessive. The proposed framework facilitates interdisciplinary planning, improves surgical precision, and supports predictable, patient-specific outcomes in complex clinical scenarios.

TTo achieve and maintain excellence and be profitable, dental practices must monitor and understand their business performance data. This involves tracking key performance indicators (KPIs), which are measurements that are critical to any business. Vital to a dental practice's success, KPIs serve as clear indicators of the general health of a practice and can reveal areas where the practice performs well and where its weaknesses lie. Tracking KPIs can open up opportunities for the practice to improve and succeed. This article defines what KPIs are, presents seven of the most important ones relative to dental practice production, and describes why practices need to track them. Monitoring these KPIs is intended to benefit any dental practice that is aiming to increase production, control overhead, and boost profitability.

This case details a 7-year follow-up of an adult patient who underwent comprehensive restorative treatment for an esthetic disability managed using established risk-based protocols. Thetreatment prioritized minimal invasiveness and functional stability without the need for orthodontic intervention. The results demonstrate long-term success and managed risks highlighting the predictability of the interdisciplinary, conservative approach that was taken. The patient continues to experience functional stability, pleasing esthetics, and an enhanced quality of life.

Dental implants are widely used to replace missing teeth, providing a long-term solution for patients seeking functional and esthetic restoration. Concerns about implant failure and post-surgical complications, however,can arise, particularly in patients with known penicillin allergies. Because penicillin is often the first-line antibiotic used for infection prophylaxis in dental procedures, alternative antibiotics such as clindamycin are commonly prescribed for these patients. Penicillin allergy is associated with a higher risk of dental implant failure than in non-allergic patients, particularly when clindamycin is used as an alternative prophylactic antibiotic. Further research is needed to explore the optimal antibiotic regimen and minimize the risks of implant failure and infection in this patient population. This article reviews the clinical implications when caring for patients with selfreported penicillin allergies receiving dental implant therapy.

The introduction of fluoride in drinking water to reduce the incidence of dental caries, once hailed as a major public health success, has recently come under scrutiny. In August 2024, a monograph from the National Toxicology Program (NTP) reported that fluoride at levels above 1.5 mg/L is associated with reduced intelligence quotient (IQ) in children. In September 2024, a US district judge required that the Environmental Protection Agency take action regarding the "unreasonable risk" posed by fluoride in drinking water. In May 2025, the Food and Drug Administration initiated efforts to remove ingestible fluoride prescription products. Effective May and July of 2025, Utah and Florida, respectively, became the first states to ban fluoride from public drinking water. These recent policy changes warrant a review of the history of fluoride's use for reducing caries, the evidence for fluoride in water and oral health products, the current criticism of fluoride, and the evidence for the effectiveness of fluoride alternatives.

This article presents a case report describing a fully digital workflow for a dual-arch All-on-4® rehabilitation, highlighting the integration of intraoral and facial scanning, mandibular motion tracking, prosthetically driven implant planning, guided surgery, and computer-aided design/computer aided manufacturing (CAD/CAM)-fabricated fixed prostheses. The patient's diagnostic pathway included intraoral optical impressions, 3-dimensional (3D) facial scanning, and dynamic jaw-motion recording to verify a new vertical dimension of occlusion. A digital smile design established a fixed prosthesis 2 (FP2)-type prosthetic concept. Guided surgery was performed with 3D-printed templates; immediate loading was achieved using prefabricated polymethyl methacrylate provisionals. After a 3-month healing period, definitive digital impressions and passive-fit verification jigs were obtained. CAD/CAM titanium frameworks and zirconia superstructures were fabricated, characterized, and delivered as screw-retained prostheses. The workflow enabled precise implant placement, accurate passive fit, stable occlusion validated by functional motion capture, and highly esthetic outcomes, all within a minimally invasive treatment concept. This case demonstrates the effectiveness of a fully digital All-on-4 approach to optimize accuracy, efficiency, and patient satisfaction in a complex full-arch rehabilitation.

In July 2025, Congress enacted major reforms to higher education funding by passing the One Big Beautiful Bill Act (OBBBA), overhauling federal student loan programs, setting limits on federal borrowing, and abruptly ending the Graduate PLUS loan program. These changes may significantly impact access to dental education-especially for students from low-income or underserved backgrounds-and further worsen the ongoing shortage of oral health clinicians in rural and underserved areas, whose populations already face challenges to receiving adequate oral healthcare.

Three-dimensional (3D) smile design has become a valuable tool for full-mouth rehabilitation, enabling precise treatment planning, enhanced patient communication, and improved case acceptance. It also increases the treatment predictability and reproducibility of the patient-approved design. Advances in in-house computer-aided design/computer-aided manufacturing (CAD/CAM) technology and ceramic materials have further streamlined the process and reduced turnaround time while enabling clinicians to overcome limitations commonly associated with traditional pressable ceramics. This case report outlines the digital workflow for the esthetic and functional rehabilitation of a patient with severely worn dentition, utilizing in-house CAD/CAM technology to fabricate lithium-disilicate glass-ceramic restorations.