Nederlands tijdschrift voor tandheelkunde最新文献

In the months prior to this special issue, an online survey was conducted. The focus was on the different views on tooth- and implant-supported fixed appliances. Unfortunately, this survey was only completed by 36 people, two-thirds of whom were men and one-third of whom were women. More than three-quarters of the people have been practicing for over 10 years. Although the number of participants is too low to draw conclusions, the results show that in the case of a solitary diastema, an implant is generally not seen as a last resort and is preferred over tooth-supported constructions. Of course, the clinical circumstances are always decisive in this. Nevertheless, the answers give rise to a more critical approach to this dilemma.

Adhesive bridges represent an important modality in contemporary restorative dentistry, offering durable, aesthetic, and functional solutions. However, a successful outcome of these restorations is highly dependent on the quality of the cementation. This article provides an overview of the cementation protocol for adhesive bridges made from different materials, addressing fundamental aspects such as material selection, tooth surface preparation, cementation techniques, and considerations regarding longevity and stability. Finally, key considerations are discussed to ensure the longevity and stability of adhesive bridges, including post-cementation care, clinical follow-up, and proper maintenance. Understanding and adhering to an appropriate cementation protocol is essential for achieving predictable and satisfactory results with adhesive bridges in practice.

In essence the resin-bonded fixed partial denture, or resin-bonded bridge, is an artificial tooth that is bonded to 1 or 2 abutment teeth. If the resin-bonded bridge is directly made with resin composite intra-orally, then the connector area is the weakest link. The alternative is to produce an indirect resin-bonded bridge in which a metal or ceramic frame spans the space between the abutments. The bridge is bonded to the abutments with composite. The moderate clinical results of the resin-bonded bridge can be associated with a deficiency of the abutment teeth preparation. Therefore, strategic preparation with grooves and rests is of substantial importance for proper support. By doing so, the longevity of the straightforward resin-bonded bridge rivals the performance of other dental provisions. There is a disagreement whether 2-unit resin-bonded bridges perform better than their 3-unit counterparts. Two optimally prepared abutment teeth are still a solid basis for a metal-ceramic resin-bonded bridge. For ceramic resin-bonded bridges, 1 abutment seems to be sufficient.

On the basis of a case, this study considers which prosthetic device is suitable as a replacement for a first molar. At the request of the patient, the least invasive option was sought. The outcome in this case was that the adhesive bridge with abutment teeth with class-2 restorations might be suitable. Of the 3 types of adhesive bridges (metal-porcelain, fibre-reinforced composite and ceramic), most experience has been acquired with the 3-piece metal-porcelain adhesive bridge. Several studies assessing the clinical behaviour of this type are available. Its lifespan is rather comparable to that of the conventional bridge on crowns, provided strategic preparation is carried out with grooves and supports to promote resistance. If the palatal or lingual surface consists entirely of enamel for bonding, it does not seem to be a problem for the wing of the bridge to be additionally bonded approximally to a composite restoration if present in the abutment tooth.

Bridges are commonly used to replace missing teeth. This article provides a comprehensive overview of the key factors influencing the performance and lifespan of various types of resin-bonded fixed prostheses. Studies comparing different types underscore the importance of achieving a balance between structural integrity and stress distribution. Material selection emerges as a crucial consideration, with zirconia highlighted as a promising alternative for durable solutions. Long-term clinical trials play an essential role in evaluating the performance of resin-bonded fixed prostheses in practice, yet they remain insufficiently available in the literature. In conclusion, this article underscores the versatile nature of resin-bonded fixed prostheses and emphasizes the importance of evidence-based approaches in clinical decision-making. By integrating insights from scientific research and clinical practice, dentists can optimize treatment outcomes and patient satisfaction when performing resin-bonded fixed prostheses.

Distal surface caries in the mandibular second molar is a common outcome of impaction of the adjacent third molar. To determine the prevalence of this type of caries in the Netherlands, 250 radiographs were evaluated. The prevalence among the research population was 26%. Risk factors for developing distal surface caries in the mandibular second molar were partially erupted/impacted third molars with a mesioangular or horizontal angulation, an LD loss of ≥ 2mm and an increased modified DMFT score. The relation between the point of contact of the third molar and the adjacent mandibular second molar, on the one hand, and, on the other, the cemento-enamel junction of the mandibular second molar and the prevalence of distal surface caries almost reached statistical significance (p = 0.052). The relatively low prevalence of distal surface caries in the Netherlands is probably related to the current clinical guidelines recommending early extraction of partially erupted/impacted third molars, particularly in cases of third molars with a mesioangular or horizontal angulation.

In January 2021, the guideline 'Periodontal screening, diagnosis, and treatment in general practice' was introduced as a successor to the so-called paro protocol. Simultaneously, the Dutch Periodontal Screening Index was replaced by the Periodic Periodontal Screening. The experiences of general dental practitioners and dental hygienists with the new guideline were evaluated in the autumn of 2022. Random groups of 1,000 general dental practitioners and 400 dental hygienists were invited to answer an online questionnaire on this topic: 125 (12.5%) general dental practitioners and 102 (25.5%) dental hygienists responded. By the end of 2022, a large majority of both groups were using the Periodic Periodontal Screening. Both professional groups were satisfied with the new guideline. Dental hygienists used the Periodic Periodontal Screening in more cases than general dental practitioners and were also more frequently satisfied with the new guideline. Both oral healthcare professionals believed that the Periodic Periodontal Screening offers better opportunities to involve the patient in periodontal care compared to the Dutch Periodontal Screening Index.

Obstructive sleep apnea is a common sleep-related breathing disorder. Although maxillomandibular advancement is widely recognized for its proven effectiveness, there are still uncertainties surrounding this procedure. This research therefore focused on the indication, surgical techniques, and outcomes of maxillomandibular advancement in patients with obstructive sleep apnea. A systematic review and meta-analysis showed that maxillomandibular advancement is more effective than multilevel surgery for the treatment of obstructive sleep apnea. Both maxillomandibular advancement and hypoglossal nerve stimulation were identified as effective and safe treatment methods for obstructive sleep apnea. Various retrospective studies also indicated that patients with hypopnea-dominant obstructive sleep apnea are better candidates for maxillomandibular advancement, in contrast to patients with cardiovascular diseases or a higher central apnea index. Furthermore, it was demonstrated that maxillomandibular advancement is effective in patients with a high percentage of central and mixed apneas, despite the potential surgical inaccuracies of maxillomandibular advancement, highlighting the broad applicability of this treatment method.

A 45-year-old woman continued to suffer from an open bite, pain in the left temporomandibular joint, jaw muscle tightness, and ringing in both ears 6 months after an unilateral left condylectomy. A recovery surgery was planned to treat the open bite and she was referred to the department for Orofacial Pain and Dysfunction for treatment of the pain complaints, muscle tightness, and ringing in the ears. At this department she was diagnosed with temporomandibular disorders. Muscle tension, oral behaviors, and anxiety were expected to play a role in the etiology. Fear for the recovery surgery contributed to the onset and maintenance of the complaints. A multidisciplinary treatment was started, including counseling, exercise therapy, psychological treatment, and stabilization splint therapy that would take place after the replacement of the temporomandibular joint. After completion of the treatment, the anxiety had disappeared, and the pain and muscle tension were reduced significantly. The remaining pain and muscle tension resolved following a successful recovery surgery and further orofacial physiotherapy.

A healthy, 49-year-old healthy woman presented at a maxillofacial surgery department with pain and a burning sensations in the mouth. She had experienced the discomfort for a year and it had made eating difficult. Clinical examination revealed white, plaque-like lesions on the buccal mucosa and tongue that could not be scraped off. A biopsy was taken by another health professional and oral lichen planus was diagnosed; treatment with triamcinolone dental paste and later clobetasol mouthwash followed. Neither treatment was sufficiently effective. A new biopsy confirmed a diagnosis of oral lichen sclerosus. Lichen sclerosus is a mucocutaneous condition commonly affecting the anogenital region, while the oral variant presents as white plaque. The differential diagnoses consisted of oral lichen planus, oral manifestations of systemic sclerosus (scleroderma) and leukoplakia. When other kinds of corticosteroid therapy are insufficiently effective, an intralesional injection of triamcinolone acetonide might be considered, which proved to be effective in this case.