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

Patients undergoing head and neck cancer treatment are prone to various orofacial complications, including immunosuppression, osteonecrosis of the jaw, mucositis, post-radiation caries, and xerostomia. Dental management can play a pivotal role in mitigating oral complications before, during, and after cancer treatment. This article identifies the most common neoplasms found in the head and neck region and their basic treatments as well as the sequalae of these treatments and the dental management of them.

The current tendency towards "minimally invasive dentistry," driven in part by a growing demand for overall esthetics, has established resin composites as the preferred material for anterior and posterior tooth restorations. Contemporary dentistry cannot be performed without resin-based restorative materials, light-curing units, and sectional matrix band systems.

Root amputation, or root resection, is a surgical procedure that can be used to remove a compromised root of a multirooted tooth, allowing the tooth to remain functional and disease-free. This technique offers an alternative to extraction with favorable long-term survival rates. Root resection involves removing the affected root, reshaping the tooth for cleansability, and, usually, restoring the underside of the tooth to prevent recurrent decay. Root resection provides patients a long-term solution with fewer surgical interventions and potential complications than implant therapy.

This study evaluates the accuracy and reproducibility of three centric relation (CR) recording techniques-bimanual manipulation (BM), chin-point guidance (CPG), and anterior deprogrammer (ADP)-using the OccluSense® (OS) digital occlusal analyzer. Addressing a critical gap in prosthodontic literature, the research employs a prospective, single-center, within-subjects design with 27 participants. Each underwent five CR registrations (BM, BM2, CPG, CPG2, and ADP) over 2 days. Statistical analyses (descriptive statistics, Cohen's Kappa, and Fleiss' Kappa) revealed that BM and CPG demonstrated substantial initial agreement with the ADP reference. However, reproducibility declined in repeated measurements. The ADP method exhibited superior consistency, reinforcing its role as the gold standard. Side-based agreement analysis highlighted operator dependency for manual techniques. The study concludes that while ADP remains the most reliable CR recording method, BM and CPG are viable alternatives when performed by skilled clinicians. Digital tools like OS enhance objectivity but do not replace clinical expertise.

Nitrous oxide-oxygen sedation is typically regarded as the safest in-office inhalational sedation method dentists can employ when treating patients with dental fear and/or anxiety. Despite a considerable inherent margin of safety with nitrous oxide-oxygen administration as a means to provide analgesia and anxiolysis in the dental office, concerns among staff workers about potential harm from environmental exposure over time have led to efforts to mitigate occupational exposure. Concerns over nitrous oxide's high global warming potential have also emerged. Recent advancements in catalytic cracking technology present a promising solution for alleviating these concerns by converting exhaled nitrous oxide into harmless nitrogen and oxygen. This article discusses the effectiveness of this technology in clinical settings, highlighting its potential to significantly reduce ambient nitrous oxide levels. By integrating these innovations, oral healthcare providers can enhance safety protocols for staff while addressing environmental challenges associated with nitrous oxide emissions, reinforcing the need for sustainable practices in anesthesia management.

This case involves the successful treatment of a patient who experienced repeated restorative failures due to an undiagnosed occlusal problem. Multiple unsuccessful attempts had been made in the past to restore the patient's mandibular incisors with direct composites, and she had become increasingly frustrated with having missing and broken anterior teeth. After a thorough records review and clinical examination were performed, an occlusal issue was diagnosed. A Kois deprogrammer was used to confirm the occlusal problem and locate a therapeutic treatment position for transitional bonding prior to placement of the final restorations. This article underscores the significance of comprehensive diagnosis and treatment planning to effectively address functional and cosmetic concerns.

In today's challenging work climate, with staffing shortages, high overhead costs, and stagnant insurance reimbursements, many dental practices may find it difficult to increase practice production. This article explores effective strategies for increasing dental practice production in the face of current industry demands. It highlights the importance of implementing foundational practice management systems to enhance performance and profitability. Key strategies discussed include expanding the patient base through proactive reactivation efforts, improving case acceptance with systematic approaches, and utilizing hygienists more effectively to maximize productivity. Additionally, the article emphasizes the significance of reducing no-shows and last-minute cancellations, which can cost practices millions of dollars in lost revenue. By recognizing opportunities that are within their control, dentists can increase production and profitability over time, leading to greater financial stability and independence even in a difficult economic environment.

The present investigation aimed to compare the treatment of gingival recession defects using either a coronally advanced flap technique and connective tissue graft (CAF + CTG) or the pinhole surgical technique and collagen membrane (PST + CM). Thirty-six subjects with bilateral gingival recession defects were included in the study. Each subject received both treatments, ie, CAF + CTG (n = 36) and PST + CM (n = 36), and completed a 1-year follow-up. Clinical and patient-centered assessments were performed, and intra- and intergroup differences were analyzed. At the 1-year follow-up, the mean recession reduction for CAF + CTG and PST + CM was, respectively, 1.98 mm ± 0.74 mm and 1.97 mm ± 1 mm (P = .53), and the mean percentage of root coverage was 65.4% ± 24.6% and 63.6% ± 24.5%, respectively (P = .72). Both groups presented significant gain of attachment level, with no significant differences between the groups (P = .9). The CAF + CTG group presented a statistically significant improvement in the width of keratinized tissue after 1 year, from 2.38 mm ± 1.5 mm to 2.61 mm ± 1.07 mm (P = .002). There was no significant difference when patient-centered outcomes were compared. Within the limits of the present study, the authors conclude that both CAF + CTG and PST + CM can successfully be used to treat gingival recession with no significant difference in efficacy between the two methods.

Often times patients present with an immediate concern, however other underlying problems may exist that might also need to be addressed in order to fully resolve the issue. In this case report, a patient presented for a limited examination and immediate treatment of a fractured mandibular right molar. She also had concerns regarding tooth wear, other fractures, and esthetics. Her high smile line revealed uneven gingival margins and a "black triangle" between teeth Nos. 9 and 10. A detailed evaluation uncovered historical temporomandibular joint changes, occlusal dysfunction, and biomechanical risks stemming from extensive restorations. Using an established systematic approach, a comprehensive treatment plan was designed to address the patient's cosmetic desires and functional issues, reduce her biomechanical risks, and create symmetrical gingival tissue to achieve a beautiful smile.

In the posterior maxilla, bone volume, height, and density are often insufficient for implant placement and rehabilitation, which can affect implant long-term stability and success. These anatomical limitations may dictate the need for sinus grafting procedures. Osseodensification is an implant site instrumentation method that enhances bone density and can also be used for transcrestal maxillary sinus augmentation. This technique utilizes bone plasticity through specially designed burs that compact and densify bone along the osteotomy walls while simultaneously propelling bone particles laterally and apically. This process generates a hydrodynamic compaction wave at the bur tip, which propels irrigation fluid into the sinus cavity lifting the membrane and simultaneously compacting bone particles grafting the sinus with autogenous bone. Additionally, the flutes of the osseodensification bur permit the operator to subsequently graft biomaterial, facilitating further elevation of the Schneiderian membrane. Current literature outlines three specific protocols for sinus floor elevation and implant placement utilizing osseodensification with residual bone height (RBH) requirements: ≥6 mm for protocol I, ≥4-5 mm for protocol II, or ≥2-3 mm for protocol III, with concurrent implant placement in the presence of adequate bone and soft-tissue volume. Osseodensification-mediated sinus grafting allows for shorter surgery duration, reduced postoperative edema, less reported pain, and subsequently decreased analgesic intake compared to lateral window techniques. This article details the step-by-step osseodensification sinus lift protocol IV, a two-stage sinus floor elevation indicated in cases of RBH ≤0.5-1.5 mm as an alternative to lateral window techniques.