Case report of multiple implant failure in a patient with ankylosing spondylitis.

This report details a case of multiple implant failure (so-called 'cluster phenomenon') in a patient with ankylosing spondylitis and considers some factors for implant failure including reduced bone density. It highlights the relationship between ankylosing spondylitis and osteoporosis although no direct link is made between these conditions and the implant failures in this case.

Management of patients with reduced oral aperture and mandibular hypomobility (trismus) and implications for operative dentistry.

Reduced oral aperture and mandibular mobility/trismus are relatively common conditions that can be encountered in patients attending general dental practice, community dental practice and district general or dental teaching hospitals. All dental specialties may see patients with these conditions, and regardless of which environment or specialty, both patient and clinician may experience significant problems. The purpose of this opinion-based paper is to identify and review the causes of such conditions, to review the development of problems encountered for patients and clinicians, and to identify options to treat or manage the conditions.

Survival of resin-bonded bridgework provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors.

OBJECTIVE: To analyse the clinical performance and factors influencing the survival of resin-bonded bridgework provided for hypodontia patients with missing maxillary lateral incisors, following orthodontic treatment to open, maintain or redistribute the missing tooth space. DESIGN: A retrospective analysis of patients treated at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Departments of Orthodontics, Child Dental Health and Restorative Dentistry, Newcastle upon Tyne Dental Hospital and School. SUBJECTS AND METHODS: Between 1989-2000, 59 suitable hypodontia patients were identified of whom 45 had complete records. For these patients 73 resin-bonded bridges (RBBs) were provided. Following invitation, 24 patients attended for a review appointment. The survival of the RBBs, grade of operator providing treatment, duration of post-orthodontic retention, the influence of design, presence of pontic contact in static and dynamic excursions, and the effect of habits were assessed. Life table, Kaplan-Meier and Cox regression analysis were carried out for the 73 RBBs with complete records. A separate analysis of the RBBs provided for patients who attended for the invited review did not show a higher failure rate than those patients who did not attend. Therefore both sets of data were combined. RESULTS: Of the 73 RBBs provided, 30 had debonded on at least one occasion (41.1%), six of these debonds were due to trauma (20%). The mean survival time of all the restorations was 59.3 months, with a median survival time of 59 months. Senior members of staff (Consultant, Senior Lecturer or Specialist Trainee) provided most restorations (n = 39) and achieved the highest mean survival of 72.6 months and median survival time of 100+ months. RBBs provided by junior staff and students had significantly lower survival times (p <0.05) compared with senior staff. Risk of failure was 3.9 times greater with junior staff and 2.5 times greater with students (p = 0.01 and p = 0.02, respectively). Analysis of all the other factors investigated showed no statistical difference in survival times or in hazard ratios. Analysis of fixed/fixed versus cantilevered bridges was limited by the number of fixed/fixed bridges (n = 11), and only two cantilevered bridges with multiple abutments were provided; both failed within one month. CONCLUSION: RBBs provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors can for many patients be an acceptable and definitive restoration. Experienced staff achieved the best results, but why this should be was not explained by the individual factors analysed in this study.

The interdisciplinary management of hypodontia: restorative dentistry.

This paper considers the role of restorative dentistry in the management of hypodontia. The paper describes the general restorative considerations common to patients with hypodontia and illustrates the variety of restorative techniques available in the restorative management of hypodontia and oligodontia.

The interdisciplinary management of hypodontia: background and role of paediatric dentistry.

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Crowns and other extra-coronal restorations: resin-bonded metal restorations.

Resin-bonded metal restorations is the final part of the series. Cast metal restorations which rely on adhesion for attachment to teeth are attractive because of their potential to be much more conservative of tooth structure than conventional crowns which rely on preparation features providing macromechanical resistance and retention.

Crowns and other extra-coronal restorations: occlusal considerations and articulator selection.

For many dentists, occlusion carries an air of mystique. It even seems sometimes that a perverse pleasure is derived in making the whole subject more complicated than it really is. As a clinician, you need to be able to decide what you expect from your proposed restoration, and to identify situations where you may need to alter the existing occlusal scheme. At a fundamental level, you also need to provide the laboratory with appropriate clinical records to ensure that when you fit them, adjustments to the expensively prepared restorations are minimal. This requires a sound understanding of the basics.

Crowns and other extra-coronal restorations: aesthetic control.

A pleasing dental appearance is the subjective appreciation of the shade, shape and arrangement of the teeth and their relationship to the gingiva, lips and facial features. Achieving such a pleasing appearance in our patients is not always easy but is critical, not least because our work is effectively on display and this has implications for patients' perceptions of our practice. To be successful, thorough assessment, careful planning and precise clinical execution is required. Every bit as important though, is good communication, both with the dental laboratory and particularly with the patient. In few areas of dentistry can effective communication be as critical as it is here.

Perceptions of general dental practitioners of a local secondary care service in restorative dentistry.

AIM: A major role of the hospital based secondary care service in restorative dentistry is to accept referrals in order to formulate treatment plans. The aim of this survey was to improve service provision at Newcastle Dental Hospital by establishing baseline quality perceptions from referring general dental practitioners (GDPs). METHOD: A postal questionnaire was sent to 393 randomly selected local GDPs, with a response rate of 67%. RESULTS: Results indicated great demand for advice and treatment which was higher than expected for temporomandibular joint problems. 42% of GDPs felt that treatment plans were not helpful and the period of waiting for a response following consultation too long. The reasons for this perception are discussed. CONCLUSIONS: The need for better communication between primary and secondary care was highlighted, as was the distinct preference of GDPs for hospital consultants rather than registered specialist practitioners to carry out specialist treatment.

Surface strains induced by measured loads on teeth in vivo: a methodological study.

Visual feedback enabled three subjects to apply predetermined near-axial loads to the incisal edge of an intact maxillary central incisor. In two subjects, principal strains and orientations developed on the labial surface of the intact incisor were resolved from strains recorded with a multiple element strain gauge. Load application was accurate and precise enough to allow resolution of strains induced by target loads of 10 to 50 N. Axially orientated compressive labial surface strains were induced by measured loads. The method could be used to validate bench-top stress analyses and investigate the effects of restoration on the structural integrity of teeth.

Retrospective survey of resin-retained cast-metal palatal veneers for the treatment of anterior palatal tooth wear.

Anterior palatal tooth wear is easily recognized, but its precise pathogenesis remains unknown. Treatment of this condition with cast-alloy palatal veneers used in combination with an adhesive cement is described. Forty-eight patients, aged 11 to 71, were treated with a total of 210 cast metal veneers over a period of 56 months. Twenty-three of the restorations failed, resulting in an overall success rate of 89%. All failures were confined to 13 patients. A glass polyalkenoate cement was less effective than a chemically active resin composite luting agent. Nickel-chromium veneers cemented with activated resin composite recorded a survival probability of 0.74 at 56 months. Adhesive cast-alloy veneers provided a useful method of restoring maxillary anterior teeth affected by acid erosion.

Psychosocial factors and adult onset rapidly progressive periodontitis.

On the basis of clinical observations, some periodontologists have suggested an association between psychosocial factors such as depression, stress and anxiety, and adult onset rapidly progressive periodontitis (RPP). This study investigated more formally possible associations between a number of relevant psychosocial factors and RPP. The significance of the psychosocial variables was assessed by comparing 3 groups: 50 patients with RPP, 50 patients with routine chronic adult periodontitis (RCAP), and 50 patients without significant periodontal destruction (controls). It was anticipated that the RPP group would show higher levels of psychosocial maladjustment than the RCAP and control groups. A between-subjects multivariate analysis of covariance indicated that the combined psychosocial variables were significantly related to the periodontal diagnosis. 2 psychosocial factors, depression and loneliness, were significant in distinguishing between groups. The RPP group presented significantly increased depression and loneliness compared to the RCAP and control groups. Future research is indicated to further clarify the significance of these psychosocial differences in relation to the onset and progression of RPP.

Odontogenic keratocyst as periradicular radiolucency in the anterior mandible: two case reports.

The differential diagnosis of periradicular radiolucencies is broad. Unusual clinical or radiographic features or failure to resolve after quality root canal treatment should be viewed with suspicion and a biopsy specimen should be submitted for histologic examination. Two cases are reported in which the presence of radiolucent lesions could have been mistaken for those of pulpal origin but were subsequently found to be odontogenic keratocysts.