Complete denture services: clinical technique, lab costs, manpower, and reimbursement. One-year review.

Complete denture services at comprehensive care public health clinics are not common in part because of clinician concerns regarding outcomes. Educational debt forgiveness has attracted recent dental graduates to public health dentistry; however, not all recent graduates receive denture education experiences necessary to attain proficiency. While fundamental patient assessment and denture construction are taught, psychological assessment and communication with denture patients requires experience. A thorough understanding of occlusion, phonetics, esthetics and laboratory steps is also necessary. Expecting recent dental graduates to become proficient providing complete dentures at minimal reimbursement levels, with no mentorship or on-site laboratory support, is unrealistic. Public health dental clinics operate at full capacity performing emergency, preventive and restorative procedures. Complete dentures come with a laboratory fee approximately one-half the total reimbursement, meaning a remake drops clinic revenue to zero while doubling expenses. It is understandable that full schedules, marginal reimbursement, unpredictability and the risk of an occasional failure block clinician interest in providing denture services. This one-year report of services describes a three-appointment complete denture technique offering improved patient and laboratory communication, reduced chair time and controlled cost, resulting in high-quality complete dentures.

There are no clearly superior methods for diagnosing, predicting, and noninvasively treating dental caries.

SELECTION CRITERIA: To be included in the systematic review, all articles were required to meet predetermined criteria: the results of the studies should be relevant to the questions posed by the project, ie, have appropriate outcome measures and an appropriate follow-up period and study design. KEY STUDY FACTOR: With respect to diagnosis, the efficacy of the various methods was compared with reference methods that included studies of extracted teeth. For prediction, the material comprised mainly prospective studies, where the reliability of risk assessment could be evaluated. With respect to treatment of early caries lesions, it was a requirement for inclusion that the study had a control group. MAIN OUTCOME MEASURE: For caries detection of accessible surfaces, visual-tactile testing was used. Radiographic diagnosis was used for approximal surfaces. For caries risk prediction, modeling was used to determine the influence of specific variables (eg, sugar intake). For noninvasive treatment assessment, size of lesion growth or shrinkage after treatment was used. MAIN RESULTS: Caries detection: Visual-tactile detection for accessible surfaces carried the best, but far from optimal, accuracy. Although specificity tends to be high with this method, sensitivity is low. Caries risk prediction: Streptococcus mutans count, salivary Lactobacillus count, salivary buffering capacity, visible plaque levels, and sugar intake have low accuracy. The best, but still far from optimal, predictor was past caries history. Noninvasive methods of caries treatment: Too few studies exist for meaningful analysis. CONCLUSIONS: (1) Past caries is the best predictor of future caries. (2) A combination of visual-tactile and radiographic examination is better than either method alone. (3) There is insufficient evidence to support noninvasive treatment of early caries. STUDY OBJECTIVE AND METHODS: To perform a systematic review of published literature to (1) determine the evidence for the effectiveness of different methods (visual-tactile versus radiographic) for detecting caries; (2) identify the most prescient predictors of dental caries; and (3) evaluate the evidence supporting the use of noninvasive methods for the treatment of caries, particularly early caries. MAIN RESULTS AND CONCLUSIONS: With regard to the questions posed by the study team: (1) Past caries is the best predictor of future caries; (2) a combination of visual- tactile and radiographic examination is better than either method alone; and (3) there is insufficient evidence to support noninvasive treatment of early caries.

Clinical evaluation of the longevity and durability of an impressionless intraoral appliance (iNterra) system.

OBJECTIVE: To clinically evaluate the durability of an impressionless intraoral appliance (iNterra) system, fabricated using a direct/indirect technique. METHODS: Fifty-three (53) appliances were fabricated using the technique and followed for a median observation period of 301 days. Appliances were evaluated by calibrated operators for adaptation to teeth, retention, stability, and paresthesia, as reported by subjects, in addition to wear. RESULTS: All restorations (100%) were rated acceptable for adaptation to teeth, retention, and stability at placement. At the longest recalls, 96.2% of appliances survived without fracture. A similar percentage (96.0%) were rated acceptable for adaptation to teeth, retention, and stability. Paresthesia (reversible malodor) was reported in one (1.9%) case. In terms of wear, 98.1% of appliances delivered were rated as "no wear evident" or "evident but acceptable wear." CONCLUSION: Overall, the evaluators agreed that the impressionless system offered procedural efficiency advantages, was clinically viable, and should be a valuable option to practitioners considering appliance therapy to control parafunctional behavior.

Clinical evaluation of a visible light-cured indirect composite for long-term provisionalization.

OBJECTIVE: To clinically evaluate a visible light-cured (VLC) resin composite system for long-term provisional and esthetic diagnostic restorations, fabricated using indirect techniques. METHODS: One-hundred and nine teeth were restored in 31 patients. Preoperational impressions were used to create VLC resin composite restorations (Radica) using indirect techniques. Restorations were relined as necessary and placed using various provisional cements at a follow-up appointment, subsequent to preparation of the teeth. Both fabricating laboratory technicians and placing dentists rated the restorations for acceptability in esthetics, marginal fit, occlusion, and functionality in various stages of provisionalization. RESULTS: All restorations (100%) were rated acceptable for esthetics prior to relining. After relining, a majority (93-100%) of restorations were rated acceptable in esthetic and functional criteria. At the placement of the permanent restoration, a majority (96-100%) of restorations were rated acceptable in esthetic and functional criteria. Terms of service ranged from two to seventy-six days. CONCLUSION: In combination with in vitro results, the clinical performance of the Radica VLC system for provisionalization and esthetic diagnostic restorations was judged to be acceptable. The system offers esthetics that are superior to conventional provisional restorations, and should be a valuable option to practitioners considering longer-term provisionalization in complex cases.

Facial slot Class II restorations: a conservative technique revisited.

Conservative instrumentation of initial posterior approximal caries is beneficial to patients and simplifies surgical management. This article describes a minimally invasive technique for preparing Class II lesions while keeping the marginal ridge and occlusal surface intact. Eradication of caries by minimally invasive techniques and restoration of tooth form after such cavity preparation necessitates specialized restorative materials that feature adhesion to tooth structure and ion exchange to facilitate remineralization. This article outlines a conservative instrumentation sequence, followed by use of a highly viscous, rapid-setting, capsulated glass ionomer cement, for the restoration of initial posterior approximal lesions.

Materiales restaurativos anticariogénicos / Anticariogenic restorative materials

Existen diferencias claras en el funcionamiento de liberación de flúor entre los cementos de ionómero de vidrio y compómeros. Sin embargo, la diferencia asociada con algunos de estos materiales con respecto a la inhibición de caries no es aún muy clara. Por otra parte, la adhesión de resina a los cementos de ionómeros de vidrio y la adhesión de ácidos a las resinas compuestas hace imposible distinguir entre resinas compuestas, compómeros y ionómeros de vidrio, ya que todos estos presentan liberación de flúor. La liberación óptima en una restauración dental depende de varias condiciones incluyendo la flora oral, saliva, dieta, contenido de mineral en los tejidos dentales y sellado marginal de la restauración. Actualmente, estudios in vitro e in vivo sugieren que los materiales que se comportan similar a los cementos de silicato en su reacción de fraguado y sus características de hidratación, funcionarán de la misma manera como inhibidores de caries. Sólo hasta que la liberación de flúor de las restauraciones dentales pueda ser cuantificada en óptimas condiciones, los estudios clínicos a largo tiempo son la mejor prueba de inhibición de caries. Cerca ya de un siglo de descubrimientos clínicos soportan el efecto anticariogénico de los cementos de silicato. Este artículo revisa la liberación de flúor y la acción anticariogénica de los materiales restaurativos usando como ejemplo el mecanismo de prevención de caries secundaria del cemento de silicato. El comportamiento de nuevos materiales será comparado a los cementos de silicato para predecir su efecto anticariogénico

Tratamiento restaurador no traumático usando una mezcla de cementos de ionómero de vidrio / Atraumatic restorative treatment using a mix of glass ionomer cements

Este artículo describe una técnica simple para el tratamiento de caries dental aguda usando una mezcla de cementos de ionómero vítreo (CIV). También se reporta una revisión de la química de los cementos, descripción de la técnica de tratamientos restaurativos atraumáticos (TRA), así como un año de resultados clínicos. Un grupo de estudiantes de odontología y un dentista colocaron 147 restauraciones TRA usando una mezcla de 50-50 de Fuji IX y Fuji Plus. Después de un a;o, 39 restauraciones (promedio 2.2 superficies) fueron examinadas por el equipo de odontólogos; treinta y seis de ellas tuvieron buenos resultados. En las zonas incisales la abrasión fue evidente, sin embargo no se observó fractura en masa o pérdida de la restauración en las restauraciones anteriores o posteriores. Dos de las tres restauraciones defectuosas estuvieron libres de caries a pesar de que presentaron falla adhesiva. La tercera restauración que falló fue reemplazada debido a que presentaba un defecto carioso en el margen cavosuperficial. Cuando las medidas restaurativas convencionales no son posibles, la técnica TRA provee efectivas y aceptables restauraciones en corto tiempo