The use of radiographs to assess the impact of the distance between the contact area and the crest of the bone to predict the presence or absence of interdental papilla: an in vivo study.

Introduction Black triangles (interdental papilla) pose an aesthetic problem for both the patient and the clinician. They also can have an impact on phonetics and periodontal health. It is useful to predict the presence of a black triangle to inform the patient of potential aesthetic compromises. The aim of this study to assess whether the risk of black triangle formation can be predicted using radiographs.Material and methods In total, 404 interproximal sites from 80 random patients attending for a periodontal assessment were measured after radiographs were digitised. The percentage of black triangles within the range of measurements of the crestal bone to the contact area from <5 mm up to 8 mm and over was then calculated.Results At a distance of 5 mm or less, the papilla was present 87.5% of the time. At 6 mm, a black triangle was present 51.4% of the time, and at 7 mm or greater, a black triangle was present 72.7% of the time. When these results were compared to other studies that had different criteria and methods, they were all very similar.Conclusion Using radiographs appears to be useful in assessing the presence or absence of a black triangle in patients who are assessed for periodontal disease, prosthetic replacement, implants in the aesthetic zone, or cosmetic treatment.

A Cone Beam CT Study on the Correlation between Crestal Bone Loss and Periapical Disease.

The aim of this study was to determine whether the degree of bone loss around teeth can be linked to the loss of vitality of adjacent teeth and periapical disease, which necessitates root canal treatments. Three hundred and twenty-one full maxilla cone-beam computed tomography scans were examined. The parameters investigated included the degree of crestal bone loss in relation to the cementoenamel junction, the presence/absence of apical periodontitis, and the presence/absence of root canal treatments. Out of the 2001 teeth examined, 696 (34.8%) showed evidence of crestal bone loss. The degree of crestal bone loss was classified as mild, moderate, or severe. A significant association (p < 0.001) was found between the presence of crestal bone loss around a tooth and root canal treatment of that tooth. It was found that it is more likely for teeth with crestal bone loss to be root canal treated compared to teeth with existing root canal treatment and healthy crestal bone levels. Furthermore, teeth with buccal or lingual crestal bone loss were significantly associated with a higher rate of periapical disease than teeth without crestal bone loss (p < 0.001). CBCT identified the severity of bone loss on all surfaces of the teeth, and the most common presentation was bone loss to the mid-root level. Teeth with crestal bone loss were significantly more likely to be associated with a higher rate of periapical disease. Teeth with crestal bone loss were more likely to be root treated than teeth with healthy crestal bone levels.

Considerations for restorative dentistry secondary care referrals - part 3: assessment of case complexity.

Assessing the complexity of a case is a challenging exercise, with many tooth-specific as well as patient-specific considerations required. This decision is not made in isolation but goes hand in hand with the assessment of restorability, as well as strategic importance, both of which have been covered by the previous papers in this series. A number of guidelines regarding this matter have been devised in order to aid clinicians in determining the complexity of their patients and thus the most appropriate setting for their treatment. This paper aims to discuss the various complexity criteria available and their application, thus aiding clinicians in managing some of the more challenging cases.

Considerations for restorative dentistry secondary care referrals - part 1: defining strategic importance.

Strategic importance is an essential concept for dental service providers. It allows clinicians to differentiate treatment needs on both a patient level and a health care commissioning level, not simply based upon complexity alone. On a patient level, it influences both the clinician's and patient's decision as to whether a tooth/teeth should be restored, as well as determining the possible need for specialist input. On a commissioning level, it facilitates the prioritisation of limited resources.Strategic importance can be considered at a patient level, taking into factors such as age, tolerance to treatment and the patient's choice. It can also be considered at a mouth level, accounting for factors such as its impact on function and aesthetics function. All these factors together can influence the decision as to whether complex treatment is warranted on a given tooth, especially in a healthcare model where the allocation of limited resources is necessary.

Considerations for restorative dentistry secondary care referrals - part 2: predictability of treatment.

The assessment of restorability is necessary to determine whether it is possible to predictably restore a tooth once primary disease has been managed.There are a multitude of factors that may determine the restorability of a tooth. It varies on a case-by-case basis and as such, clinicians must consider both local tooth factors and general patient-related factors, ensuring a holistic approach when assessing these patients.This article discusses the many factors that determine a tooth's restorability, including a review of the current indices available to clinicians to aid in this process.

Comparison of imaging modalities in the diagnosis of external cervical resorption (ECR): an in-vitro study.

External cervical resorption is a pathological condition affecting the cervical margins of teeth. Due to the increased prevalence and the area it affects, it can be easily misdiagnosed. The ability of clinicians to diagnose ECR and subcategorise the lesions using periapical radiographs and cone beam-CT scans has not been investigated in-depth. This study aims to assess if diagnostic ability to detect ECR lesions with the two modalities was different and if there was a change in the diagnosis when CBCT was used. A human skull, including the mandible was used for this study. The teeth were randomly allocated to the different subcategories, then pre and post-preparation radiographs with CBCT were taken. Statistical analysis was done using IBM SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). The study sample was composed of 60 participants, the overall sensitivity of intraoral radiographs was significantly lower than CBCT. When the participants were told the radiograph and the CBCT were of the same tooth 60% said they would change their diagnosis. The use of intraoral radiographs alone might not be enough to identify and correctly diagnose ECR lesions. CBCT can give a better idea about the nature and the extent of the lesion.

Current technology in endodontic instrumentation: advances in metallurgy and manufacture.

Since the introduction of nickel-titanium endodontic instruments, there have been a myriad of developments which can be confusing and sometimes contradictory. This article seeks to review and articulate these advances, and allow the reader to better understand the benefits and the limitations of the systems available. Ultimately, this helps clinicians to engage more confidently with trade and have a more informed choice of the most appropriate file to use for each individual endodontic case. All this should facilitate more predictable endodontic outcomes.

Intentional replantation - a clinical review of cases undertaken at a major UK dental school.

Introduction Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth in select cases. This case series demonstrates the use of IR as an alternative treatment approach to both orthograde and surgical endodontic retreatment. The indications, contraindications, benefits and risks of IR are discussed, and the clinical procedure is outlined.Setting Restorative Department, University Dental Hospital of Manchester, UK.Case reports Of the 13 cases presented, the follow-up period before discharge ranged from 3-28 months. Only one tooth which presented intra-operative challenges required extraction three months after IR due to post-operative mobility.Conclusion In select cases, IR may provide a simple, less invasive and cost-effective alternative to both endodontic retreatment and extraction alone following appropriate training.

Patients' ranking of interdental "black triangles" against other common aesthetic problems.

The purpose of this study is to assess patients' aesthetic perceptions of interdental "black triangles", both in terms of the number of triangles visible and their severity; and to ascertain how patients rank the presence of "black triangles" against other aesthetic problems. It is based on a questionnaire of 80 randomly selected individuals who were asked to rate the aesthetics of digitally-manipulated images. Patients'perceptions of interdental "black triangles" were compared with their perceptions of other 'non-aesthetic' features. Interdental "black triangles" were rated as the third most disliked aesthetic problem below caries and crown margins. This study demonstrates the importance of interdental "black triangles" to patients, and therefore, as they can occur during prosthetic treatment, must be discussed with patients prior to commencing therapy.

Crown lengthening surgery--indications and techniques.

UNLABELLED: Crown lengthening is a surgical procedure aimed at removal of periodontal tissue to increase the clinical crown height. As a restorative dentist using this technique of crown lengthening, one needs to have an understanding of biological width, indications, technique, as well as some possible limitations. The authors aim to discuss these concepts in order that the restorative dentist can use crown lengthening as part of an overall treatment plan in a controlled and predictable manner, taking into account biological factors. CLINICAL RELEVANCE: Today's restorative dentist faces an apparent increase in patients exhibiting toothwear that may result in shortened teeth, making crowning these teeth problematic. In addition, it is evident that patients are becoming more aware of the importance of a pleasing smile. This article discusses crown lengthening as one way in which the restorative dentist can address both clinical demands.