Replacement of Maxillary Permanent Central Incisors Lost Due to Trauma in the Mixed-Dentition.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile that is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

Management of a Dental Implant with Internal Thread Damage. A Patient Treatment Report.

When a patient presents with an implant with the internal threads damaged (or cross-threaded), a definitive restorative challenge may be faced. By having a difference in hardness between an abutment screw and the implant to which it is to be attached, there is potential for internal thread damage to the implant if the opposing threads do not interface properly. As such, the operator must use care when positioning the abutment and engaging the threads to prevent possible misalignment and damage to the internal aspect of the implant body. This article describes such a situation and the action taken to overcome the problem.

Replacement of maxillary permanent central incisors lost due to trauma in the mixed-dentition.

Traumatic injuries to anterior teeth in children range from minor chipping to total tooth loss and occur more often in boys than in girls. The treatment of permanent tooth loss in younger patients is complicated by the difficulty of doing restorative procedures which may be influenced by pulpal size, clinical crown height, and a dental profile which is constantly changing. This case report presented a situation involving a 9-year-old boy who had experienced traumatic loss of the maxillary central incisors. Innovative materials coupled with sound principles of removable partial denture design were utilized to fabricate a cast metal removable denture prosthesis to satisfy the esthetic, functional and psychological dental needs of the patient and his parents.

Flexible removable partial dentures: a basic overview.

For many years, flexible resin materials have been available for fabricating removable partial denture (RPD) prostheses. Using a nonrigid material for the major connector or other components of an RPD may be a consideration for certain patients. Except for the promotional literature that has been written for flexible resin dentures, there is very little information available in the dental literature concerning nonrigid RPDs. As a result, the decision to use this treatment option depends on the judgment and experience of the dentist and fabricating laboratory. This article summarizes clinically pertinent information about flexible, nonrigid partial dentures.

Intraoral gothic arch tracing.

In order to create optimum esthetics, function and phonetics in complete denture fabrication, it is necessary to record accurate maxillo-mandibular determinants of occlusion. This requires clinical skill to establish an accurate, verifiable and reproducible vertical dimension of occlusion (VDO) and centric relation (CR). Correct vertical relation depends upon a consideration of several factors, including muscle tone, inter-dental arch space and parallelism of the ridges. Any errors made while taking maxillo-mandibular jaw relation records will result in dentures that are uncomfortable and, possibly, unwearable. The application of a tracing mechanism such as the Gothic arch tracer (a central bearing device) is a demonstrable method of determining centric relation. Intraoral Gothic arch tracers provide the advantage of capturing VDO and CR in an easy-to-use technique for practitioners. Intraoral tracing (Gothic arch tracing) is a preferred method of obtaining consistent positions of the mandible in motion (retrusive, protrusive and lateral) at a comfortable VDO.

Direct chairside hard reline at delivery of a newly fabricated distal extension removable partial denture: considerations and techniques.

The stability of a dental prosthesis is its resistance to displacement when it is subjected to functional, horizontal and rotational stresses. For a removable partial denture (RPD), stability depends greatly on overall quality of fit to the supporting teeth and tissues. There are numerous reasons why the fit of a newly fabricated RPD might be compromised, but it is easy for the dentist to determine visually whether vertical movement is excessive. If finger pressure applied to the distal-most tooth on a distal extension denture base results in lifting of the anterior-most indirect retainer, then the RPD is not stable and either an indirect (laboratory processed) or direct (chairside) hard reline should be carried out. In this paper, we discuss factors that might influence the need to do a direct, chairside hard reline at delivery of a newly fabricated distal extension RPD and we recommend techniques.

Decision-making for treatment planning a cantilevered fixed partial denture.

Considerable controversy exists in the dental literature regarding cantilevered pontics. This article discusses basic concepts of the cantilever fixed partial denture (CFPD) in which one cantilevered pontic is supported by only one or two abutment teeth. Three primary factors should be considered carefully to optimize the prognosis for a CFPD: abutment selection, control of functional forces, and rigidity/strength of connectors. Abutments should have a root surface area greater than the tooth being replaced and a crown-to-root ratio of 2:3. They also should exhibit minimal mobility and be vital and periodontally sound. Contact on cantilevered pontics should be light in centric position and nonexistent in excursions. CFPDs ideally should be metal or metal-ceramic, and connectors, which are high-stress areas, require bulk for strength. A cantilevered prosthesis may require more consideration and planning than a conventional fixed partial denture, but when kept within the patient's biological limitations and executed properly, can provide a restorative option with many advantages.

Vital tooth cleaning for cementation of indirect restorations: a review.

This article reviews factors that must be considered to select the best technique for cleaning a vital tooth prior to cementation of a definitive restoration. The dental literature offers many suggestions with supporting rationales. In cases where provisional cement has been present or contrast powder has been used, some mechanical cleaning (with fine pumice or prophy paste) appears to be justified. The value of soaps or other chemicals is questionable except perhaps as topical disinfectants. Dentists should be aware that a cleansing agent may have a negative or positive effect on bond strength, depending on the adhesive system chosen. It may be necessary to tailor the particular method of tooth cleaning to the cement that is to be used.

Unilateral semi-precision removable partial denture utilizing Bredent VKS-SG attachment system.

There are various options for removable partial dentures. A removable partial denture fills in the space created by missing teeth and restores the smile. The semi-precision attachment is a way to clasp a removable partial denture (RPD) to existing abutment teeth in order to provide greater stability and retention without having a visible clasp assembly. In this report, we show how the Bredent VKS-SG ball attachment provides balanced support to a Kennedy Class III edentulous area, maximizing esthetics, stability and retention with low maintenance and exceptional patient comfort.

Should preclinical typodonts be disinfected prior to grading?

This is a report of a unique finding in a preclinical laboratory that may be a potential dental school health hazard. Visual inspection (conducted in April 2008 by a preclinical crown and bridge course coordinator) of typodonts used by second-year students at the University of Mississippi School of Dentistry found that fourteen out of thirty-nine had black spots on the undersurface of the cheek shroud and/or plastic gingiva. The spots were cultured by the Medical Center's Department of Microbiology and described only as being mold/fungus typical of that which frequently grows in warm, moist, southern environments. Although indoor molds are common, about 5 percent of the general population will develop some type of mild allergic airway problem from molds over their lifetime. Mold on typodonts is unsightly, indicates failure of students to recognize the value of cleanliness in the dental environment, and may be a potential health hazard for some individuals. Cleaning and drying procedures for typodonts were implemented. The transfer of items between students and instructors during preclinical courses provides many opportunities for the spread of potentially harmful microorganisms/viruses. As a minimal level of personal protection, it is suggested that instructors wear disposable gloves and face masks and exercise hand washing between handling student instruments and typodonts. This problem has not been previously mentioned in the literature and merits further investigation/discussion.

Who is teaching undergraduate prosthodontics in US dental schools, 2007?

PURPOSE: The shortage of full-time dental school faculty along with a slow steady increase in student enrollment is not a new phenomenon. The purpose of this study was to determine who is teaching undergraduate prosthodontics in US dental schools-what percent are full-time faculty; what percent are prosthodontists; and what percent are board-certified prosthodontists-to allow schools to make a real-time comparison of the composition of instructors they have teaching prosthodontics to the apparent status quo. MATERIALS AND METHODS: A short, ten-question survey was sent via e-mail to representatives at the 55 undergraduate US dental schools. A cover letter explained the nature of the study and requested participation and electronic return of the survey. Three weeks after the initial request, an aggressive follow-up was conducted to schools that had not returned the survey. Answers were converted to percentages to compensate for differences between schools with many or few instructors. Schools were also grouped by location to see if regional differences exist. RESULTS: Thirty-eight (69%) of the surveys were completed and returned. In general, the division between full-time and part-time instructors is about 50%. More removable prosthodontic instructors (60%) than fixed instructors (44%) are prosthodontists, and only a small percentage of the total (18% removable and 15% fixed) have completed board certification. The South and Midwest had the highest percentage of prosthodontists involved in teaching; the South had the highest percentage with specialty board certification. CONCLUSION: This study indicated that only a few schools are fortunate enough to have sufficient full-time, specialty-trained faculty available for complete coverage of all undergraduate prosthodontic courses and clinics. The information presented serves as a baseline for future comparison to see if the percentage of full-time and/or specialty-certified prosthodontic faculty changes.

A practical review of prevention and management of ingested/aspirated dental items.

Most dental procedures are accomplished while the patient is partially or totally supine; as a result, all restorative patients have the potential to ingest or aspirate a dental item. The principle of nonmaleficence dictates the use of preventive practices (rubber dam, ligatures, throat pack) when possible; even so, accidents happen and one has to assume the worst when a dental item disappears. Knowing what to do can be extremely important, both medically and legally. The first order of business is ensuring that the airway is not compromised and advising the patient of the problem. Immediate referral (with escort) to a medical facility for appropriate radiographs and determination of required medical action is mandatory, regardless of how well the patient looks. According to the literature, all aspirated foreign objects and approximately one-third of ingested items require the patient to be hospitalized. Proper documentation also is important to reduce liability in the event of litigation.

Do dental educators need to improve their approach to teaching rubber dam use?

Most dentists are educated in rubber dam use in dental school, but there is often disparity between what is taught for various restorative procedures and what is practiced in the private sector. It is a common, although undocumented, belief that few practicing dentists routinely use rubber dam isolation. This study repeated a survey conducted in 1985 evaluating U.S. general dentists' attitudes toward rubber dam usage to see if improvement is needed in current dental educators' approach to this topic. Four hundred dentists were selected randomly from ten major geographically diverse cities using the website YellowPages.com. Each was mailed a letter requesting survey participation, which included a pre-stamped, pre-addressed postcard with the survey printed on the back. The target population, general dentists, returned 164 surveys (41 percent). Their responses can be summarized as follows: 71 percent do amalgams-of those, 53 percent never use a rubber dam whereas 12 percent always use a rubber dam; 100 percent do anterior direct resin composites-of those, 45 percent never use a rubber dam whereas 17 percent always use a rubber dam; 98 percent do posterior direct resin composites-of those, 39 percent never use a rubber dam and 18 percent always use a rubber dam; and 78 percent do endodontic procedures-of those, 11 percent never use a rubber dam whereas 58 percent always use a rubber dam. Most (74 percent) felt that their dental school rubber dam training was adequate; 42 percent felt that its use has an effect on the quality of restorative dentistry. Their most common reasons for not using a dam were the following: inconvenience (40 percent); unnecessary (28 percent); other (12 percent); patient refusal (11 percent); and time (9 percent). No respondent indicated that "cost" was a reason for not using rubber dams. This study indicates that many general dentists in this country continue to ignore the rubber dam for many restorative and some endodontic procedures. It indicates that predoctoral dental educators need to look for opportunities for improvement to reduce the discrepancy between what is taught and the general practice of dentistry.

Implant abutment screw torque generated by general dentists using a hand driver in a limited access space simulating the mouth.

For various reasons, dentists may be tempted to definitively tighten implant abutment screws using only handheld screwdrivers. The purpose of this study was to test the ability of general dentists to generate implant abutment screw preload using a simple screwdriver in a limited-access space simulating the mouth. Results indicated that mechanical torque wrenches must be used in posterior areas of the mouth to establish sufficient preload, and dental experience is not a major factor in the ability to tighten an implant abutment screw.

Dental cements for definitive luting: a review and practical clinical considerations.

Dental cement used to attach an indirect restoration to a prepared tooth is called a luting agent. A clinically relevant discussion of conventional and contemporary definitive luting agents is presented in this article. Physical properties are listed in table form to assist in comparison and decision-making. Additional subtopics include luting agent requirements, classifications, retention and bonding, cement considerations for implant-supported teeth, and fatigue failure.

Eye safety practices in U.S. dental school restorative clinics, 2006.

This study was conducted to determine how much progress U.S. dental schools have made in providing eye protection during restorative (adult operative and fixed prosthodontic) procedures since a 1979 survey. A seven-question survey was placed at a website, and fifty-five different U.S. dental schools were asked to complete the survey. Thirty-one schools responded (56 percent). Eighty-four percent of schools had safety glasses available for patients, but only 77 percent required usage during restorative procedures. Similarly, while 87 percent of schools required dental students working in restorative clinics to wear safety glasses, just 73 percent enforced the policy. Additionally, 84 percent provided blue light protection on curing lights and required students to wear eye protection while doing lab procedures. Compared to the 1979 survey, considerable progress has been made over the last twenty-seven years in protecting dental school patients and students from ocular injuries. Because one would hope to have 100 percent compliance on this issue, there is room for improvement in promoting patient eye safety and teaching good habits to dental students.