Annals of the Royal Australasian College of Dental Surgeons最新文献

The impacted canine is relatively common in incidence and can often lead to difficult treatment planning decisions. Cone Beam Computed Tomography (CBCT) imaging has improved diagnosis and treatment planning of impacted canines. In particular, this technology has allowed the clinician to accurately locate and visualize these teeth better than ever before, as well as greater appreciate the degree of damage to neighbouring teeth such as lateral incisors. Improved diagnosis and treatment planning with CBCT has therefore resulted in improved treatment outcomes. The objective of this presentation will be to cover the incidence, complications and management of impacted canines from an orthodontic perspective. Impacted canines are commonly cited as occurring in 1% of the population. Complications of impacted canines include root resorption and devitalization of the adjacent lateral incisor, ankylosis, cyst formation and prolonged retention of the deciduous canine. Interceptive management of impacted canines may include the removal of the deciduous canine. Managementof impacted canines also include either their removal or orthodontic movement into their correct position.

Minimum intervention dentistry, with its non-operative prevention and control of disease, underpins the basis of a patient-centred, team-based approach to managing dental caries in patients, who must take an active responsibility in maintaining their personal oral health. In patients where cavities are present causing pain, poor aesthetics and/or functional problems, restorations will need to be placed. Minimally invasive caries excavation strategies can be deployed depending on the patient's caries risk, lesion-pulp proximity and vitality, the extent of remaining supra-gingival tooth structure and clinical factors (e.g., moisture control, access) present in each case treated. Excavation instruments, including burs/handpieces, hand excavators, chemo-mechanical agents and/or air-abrasives which limit caries removal selectively to the more superficial caries-infected dentine and partial removal of caries-affected dentine when required, help create smaller cavities with healthy enamel/dentine margins. Using adhesive restorative materials, the operator can, if handling with care, optimize the histological substrate coupled with the applied chemistry of the material so helping to form a durable peripheral seal and bond to aid retention of the restoration as well as arresting the carious process within the remaining tooth structure. Achieving a smooth tooth-restoration interface clinically to aid the co-operative, motivated patient in biofilm removal, is an essential pre-requisite to prevent further secondary caries.

As the oral cavity marks the beginning of the gastrointestinal tract (GIT), it is not surprising that it frequently mirrors disease that occurs lower in the GIT. Increasingly, clinical signs in the oral cavity are recognized as future predictors and prognostic indicators of GIT and, indeed, other systemic disease. This paper discusses recent advances in the overlap area of Oral Medicine and Gastroenterology and the significant role of the dental practitioner in the management of these patients.

The rates of lifestyle-related diseases are increasing. Worldwide there is an obesity epidemic, one of the consequences of which is an overwhelming increase in type 2 diabetes, not only in adults, but also in children and adolescents. Many cases are currently undiagnosed resulting in serious complications and placing individuals at increased risk for cardiovascular disease. As many diseases share common risk factors, the current emphasis is on primary prevention and risk assessment by all health care providers to enable detection and early intervention. Lifestyle factors that impact on oral health can also have an impact on general health, and lifestyle behaviours that promote better oral health can decrease the risk for chronic disease. In this context, changing oral health behaviour to promote better oral health may directly impact on improving general health for all age groups. Risk assessment for systemic diseases in the dental setting is explored to provide dental professionals with a framework for promoting better overall health for their patients.

The number of patients presenting with severe attrition and associated erosion is increasing in frequency. Treatment of this patient group is very challenging as it is simply not just a case of replacing lost tooth tissue, but also trying to identify and then eliminate the aetiological factors responsible for the loss of tooth structure. In most cases restorative treatment involves extensive rehabilitation of the dentition to restore the aesthetics and function and also to prevent further tooth loss. Such treatment often involves a multidisciplinary approach to eliminate and/or reduce causative factors prior to definitive restoration of teeth. Treatment needs to focus on quick intervention when the problem has been identified and diagnosed. Restorative treatment involves careful if not complex planning culminating in the establishment of a well defined and ongoing maintenance plan. Long-term success of treatment is centred on the maintenance phase. Current restorative options include the use of extensive resin composite build-ups. This is often the best initial starting point as it allows for adjustments, as well as being a reversible and more conservative procedure. The use of indirect restorations is likely to provide a longer lasting outcome after initial stabilization, whether it is metal- or ceramic-based or a combination.

In recent years orthodontic treatment has been revolutionized by the introduction of skeletal anchorage or temporary anchorage devices (TADs). Many malocclusions, which have been previously only treatable through orthognathic surgery, such as skeletal open-bites, can now be managed non-surgically with less biological cost to the patient. Furthermore the recent application of TADs in the treatment of growing skeletal Class III patients is not only minimizing the need for obtrusive appliances, such as head gear and face masks, but it is also proving to deliver better and superior results to conventional growth modification protocols with more patient acceptance and less need for compliance. This overview covers the applications of TADs in the treatment of skeletal open bites and skeletal Class III malocclusions with reference to current evidence and clinical case presentations.

Geriatric healthcare has already changed. We are living longer and we are enduring those additional years with more severe chronic disease and a greater number of chronic diseases. Current mechanisms to improve oral health care for individuals and the community are considered in this paper. We are still yet to measure the effectiveness of these changes. Even more complex is the confusion and conjecture about what we should be measuring and whether what we measure actually has an impact on the quality of life.

A barrier to providing sealants has been the concern about inadvertently sealing over caries, but today the management of dental caries has evolved from the domain of techniques based on complete removal of carious tissue prior to tooth restoration or sealant, to include a range of techniques where some, or even all caries is sealed in beneath restorations, sealants or infiltrants. There is a significant, and growing, evidence base supporting these techniques as caries management strategies for children and adolescents. These techniques are not new but build on earlier concepts and research. These concepts offer a real way forward and departure from invasive restorative treatments. Some issues, however, are not completely resolved, and future solutions may herald a new era of restorative dentistry, perhaps with the concept of filling with no drilling since the "seal is the deal". These techniques and issues will be considered in the New Zealand context.

It is a well-understood fact that the world's population is ageing. Concomitant with that is an increase in the chronicity of disease including dental disease. The challenges faced by the dental profession in managing patients as they age are becoming increasingly important. What do we know and understand about diseases and their impact on dental health in the elderly? What role do salivary dysfunction and biofilms play and how are these integrated with general and oral health? Are we really prepared to manage the impact of these factors and what is the profession doing to better equip itself for the inevitable change to dental practice that is likely to ensue? Dental education in Special Needs Dentistry and in particular geriatric care expands beyond the realms of the University setting. There is potential to expand knowledge in dental care amongst the elderly through continuing professional development that is now mandatory across Australia and New Zealand. Training should not be limited to University curricula. It should extend to include medical and allied health staff, staff in aged care facilities and all those involved in policy and decision making for the elderly. The aim of this paper is to address where education in geriatric oral health is currently placed and the role to be played by all key stakeholders from University to Community arenas.

The aim of the study is to compare the prevalence of post-operative inferior dental nerve (IDN) deficit after coronectomy with total removal of wisdom teeth showing specific radiographic signs of close proximity to IDN. A randomized clinical trial comparing total removal and coronectomy of wisdom tooth was conducted. Analyses of the correlations of IDN deficit and various radiographic signs of wisdom tooth roots showing close proximity to IDN were performed. Two radiographic signs were found to be positive predictors ofintra-operative IDN exposure. Specific radiographic signs or the presence of two or more radiographic signs are positive predictors of post-operative IDN deficit. The study concluded that darkening of the wisdom tooth root and presence of two or more specific signs in radiographs significantly increased the risk of IDN deficit in lower wisdom tooth surgery. Coronectomy can significantly reduce the prevalence of an IDN deficit in patients with lower wisdom teeth showing radiographic signs of close proximity to IDN. It also carries less surgical morbidities when compared with total removal of lower wisdom tooth.