An Efficient and Cost-Effective Technique to Construct an Intraoral Central Bearing Tracing Device.

Intraoral central bearing tracing has been shown to be a predictable way of recording and verifying centric relation position for patients. Existing tracing devices are challenging to use due to several significant clinical limitations. In comparison to commercially available counterparts, this article presents a technique that simplifies instrumentation and clinical steps to make an intraoral tracer for making centric relation records, determining occlusal vertical dimension, and detecting deflective occlusal contacts in edentulous patients.

Assessing fit at the implant-abutment junction with a radiographic device that does not require access to the implant body.

STATEMENT OF PROBLEM: Radiograph paralleling devices provide an excellent means of obtaining orthogonal radiographs for the evaluation of the fit of implant restorations. Unfortunately, the clinical applicability of such devices is a significant issue because access to the implant body must be obtained at each radiographic appointment. PURPOSE: The purpose of the study was to investigate whether the fit or microgap at the implant-abutment junction could be more accurately and confidently assessed with a novel radiograph paralleling device that did not require access to the implant body once a proper registration index was made. MATERIAL AND METHODS: Microgaps of 0, 50, and 100 µm were introduced at the implant-abutment junction of a provisional implant crown in a manikin-typodont assembly. Dental assistants made 54 radiographs (18 per microgap) of the crown with and without a radiograph paralleling device; 9 clinicians then evaluated the standardized radiographs for the presence of misfit. The Cochran-Mantel-Haenszel test and the corresponding odds ratios were used to evaluate the effectiveness of the paralleling device in helping clinicians better assess misfit from the radiographs made. RESULTS: The use of the device led to a higher percentage of accuracy under all conditions (79.0% vs 70.4% at the 0-µm gap, 77.8% vs 16.1% at the 50-µm gap, and 100% vs 92.6% at the 100-µm gap); the improvement was statistically significant at the 50-µm gap (P<.001) and 100-µm gap (P=.049) but not at the 0-µm gap (P=.364). The odds ratio (95% confidence interval) of obtaining correct versus wrong answers with the device compared with without the device was 18.64 (7.94-43.77) at the 50-µm gap and 5.40 (0.25-114.25) at the 100-µm gap. CONCLUSIONS: The study indicated that the paralleling device helped the clinician more accurately assess the implant-abutment junction with the 50- and 100-µm gaps.

A radiograph positioning technique to evaluate prosthetic misfit and bone loss around implants.

A radiograph positioning device was developed to fit with commercially available film holders and implant systems. The device is indexed to the dental implant body and the adjacent dentition by using an implant placement driver and polyvinyl siloxane occlusal registration material. By fitting the device to a conventional film holder, accurate orthogonal radiographs can monitor changes in bone architecture and prosthetic misfit.

Oromandibular reconstruction: the history, operative options and strategies, and our experience.

Oromandibular reconstruction resulting from resection of benign tumor, malignant cancer, osteomyelitic or osteoradionecrotic mandible remains a challenge for plastic surgeons today. At present, fibula osteocutaneous flap is the perhaps most commonly used technique for oromandibular reconstruction because of its potential for contouring, immediate dental implant placement, and favorable donor site morbidity. In this study, we review the history of oromandibular reconstruction, summarize the characteristics of different osteocutaneous flaps, offer surgical options of different osteocutaneous flaps, and provide reconstructive strategies for different locations of mandibular defects. Furthermore, we give a detailed description of various modifications in oromandibular reconstruction: (1) the myoosseous flap for lateral segmental defect repair may reduce donor site complication; (2) to improve the function of oral commissure in patients with obscure recipient vessels, we modify the fibula osteocutaneous flap with anterolateral thigh flap and combine the tensor fascia lata using one set of recipient vessel for composite oromandibular reconstruction; (3) to decrease the likelihood of neck infection and improve aesthetic result, we add the segmental soleus muscle to the fibula osteocutaneous flap to obliterate and augment submandibular dead space. Lastly, dental rehabilitation considerations associated with mandibular reconstruction have been given to help assist in surgical treatment planning.

Behavior-associated self-report items in patient charts as predictors of dental appointment avoidance.

Dentally anxious patients with long-term avoidance behavior may experience treatment complications and induce stress in the dentist. Since dental anxiety scales are seldom used clinically, it is valuable to investigate the strength of behavior-associated items in the current patient chart in predicting canceled or missed appointments. Charts from a sample of patients (N=357) who visited the UCLA Dental Center January 2006 to June 2006 were examined for self-reports of depression, moodiness, nervousness, and anxiety. Multivariate regression indicated that reported feelings of depression, moodiness, and prior appointment avoidance due to fear were strong predictors for canceled or missed appointments. Reported anxiety or nervousness did not predict missed appointments. Although studies have shown that anxious patients who have completed behavioral-cognitive therapy were more likely to maintain regular dental care, the lack of prediction from anxiety or nervousness implies that dental anxiety may not play a direct role in patient compliance with attending dental appointments. By examining the relation of additional temperaments to appointment avoidance, a self-report questionnaire can be developed to identify patients with emotional distress and tailor interventions to decrease missed appointments.