Chairside Time Research Articles

Bond reliably-difficult areas... Easy solutions !!

Bonding is an integral part of an Orthodontic treatment; but its simplicity can be One of the most frustrating experiences in an Orthodontic office is debonding of brackets ; their reasons being multifactorial. It can be either due to faulty bonding procedures employed by the Orthodontist or faulty food habits by the patients. Yet another reason are the clinical conditions which make placing brackets very difficult. As time has evolved, Orthodontics has widened its horizons and more and adults are undergoing this treatment. As much as we are promoting the 'Interdisciplinary Approach', wherein the orthodontist uses adjunctive procedures to enhance the overall treatment plan, the difficulties regarding the bonding procedures are increasing. Some of these challenging conditions include bonding on impacted, partially erupted, ectopically positioned, severely rotated and fluorosed teeth, cross bite, deep bite cases, various restorations, prosthesis, wet field bondings, Lingual Orthodontic procedures and Adjunctive procedures in adults using Interdisciplinary approach. Hereby some different ways to bond these difficult surfaces will be discussed in this review which are an inhibition to an Orthodontist yet routinely encountered, thus saving on chairside time and achieving low bond failure rates.

Modified functionally generated path technique for single complete denture against non-modified natural dentition

A clinical report of a patient complaining of frequent fractures of her maxillary complete denture opposing dentulous mandibular arch is presented. The patient was rehabilitated with a maxillary complete denture using modified functionally generated path technique to achieve harmonious occlusion between the complete denture and the natural dentition. Using the patient's own denture to record the functionally generated path made the technique much easier and also saved valuable chair-side time. Occlusal balancing in the trial denture bases gave us the flexibility to move the teeth slightly, or grind them in order to balance the occlusion. Our modification of the functionally generated path technique resulted in successful rehabilitation of the patient without any fracture of the prosthesis in the 2-year follow-up, and has saved valuable chair-side time and laboratory effort.

MATRIX BUTTON PROVISIONALS

AbstractFabrication of provisional restorations has been explained using different materials and techniques in the past. Formation of an external matrix before preparation of the abutment, which is later used in combination with a resin material, is one of the techniques. Here, a new material has been used as matrix in direct, indirect and indirect-direct methods to produce esthetic and functional provisional restorations. There is neither wasting of chair side time nor a second visit for the patient.

Do you do Damon®? What is the current evidence base underlying the philosophy of this appliance system?

Self-ligating bracket systems are increasing in popularity amongst orthodontists. This reflects their high quality engineering, improved reliability and relative ease of use. However, it might also be related to claims of superior function made by the manufacturers of these appliances. In particular, the Damon(®) appliance system claims to offer significant advantages to both orthodontist and patient over conventional-ligation and other forms of self-ligated appliances. We have reviewed current literature relating to use of the Damon(®) appliance system. There is some evidence to suggest this appliance may lead to reductions in chairside time for the orthodontist, particularly those experienced with this system, in comparison to conventional-ligation. However, evidence that pain experience is reduced for the patient when using Damon(®) brackets is not conclusive. In the presence of identical archwire sequences, there is no evidence that Damon(®) brackets can align teeth faster or in a qualitatively differently manner, when compared with conventional-ligation. There is no high quality evidence that treatment with the Damon(®) appliance takes place more rapidly or leads to a superior occlusal or aesthetic result. Indeed, the best available evidence would suggest there is no difference in treatment outcome or time, at least in extraction cases. There is no evidence that treatment with the Damon(®) appliance is more stable. Claims relating to improved clinical performance of the Damon(®) appliance system are currently being made to orthodontists and patients that are not substantiated in the scientific literature.

SHEAR BOND STRENGTH OF LASER CURED COMPOSITE RESIN FOR DIRECT BONDING OF ORTHODONTIC BRACKETS-AN IN VITRO COMPARITIVE STUDY

Aim and objectives: To determine the shear bond strength of laser cured composite resin and compare with that of visible light cure resin and evaluate it’s clinical usefulness. Materials and methods: An argon laser with a wavelength of 488-500nm and a power density of 2.104 mW/cm2 and an optical diameter of 6mm with a curing time of 10 seconds was employed as against the visible light cure with a wave length of 450-500nm of the same optical diameter and curing time of 40 seconds and tested using a universal instron testing machine. Results: The bond strength between laser cured and visible light composite resin was not statistically significant. However the lesser curing time of laser reduces the chair side time. Conclusion: Laser curing of orthodontic brackets may not be a viable procedure due to the cost factor as the bond strength is clinically insignificant.

COMPARATIVE EVALUATION OF EFFECTIVENESS AND EFFICIENCY OF TWO COLOR CHANGING BRACKET BONDING ADHESIVES- A PROSPECTIVE CLINICAL STUDY

Introduction: The aim of the study was to evaluate and compare the clinical performance of two color changing bracket bonding adhesives (Transbond Plus and Grengloo), in terms of bond failure rate, bonding time and time taken by the adhesives to change color. Methods: Eight consecutive patients seeking orthodontic fixed appliance therapy were bonded using Cross arch Split mouth technique, which involves the placement of two varieties of bracket bonding adhesives in diagonally opposite quadrants and cured using a visible light curing unit. The time taken by the adhesive to change color during bonding and the bonding time was noted using a stop watch. The bond failure rates of both the adhesives were evaluated by a thorough follow up of individual case, as and when they reported to the department with a debonded bracket. The data collected were subjected to statistical analysis using Chi square test and student’s t-test. Results: The overall bond failure rate for two color changing adhesives were 7.1 % and 8.6 %,bonding time was 59.1 and 57.4 seconds per tooth and time to change color was 45.9 and 46 seconds. Interpretation & Conclusion: There were no significant differences between the failure rates, bonding time and time taken by both the adhesives to change color showing that both are clinically efficient and effective. Clinically they are preferred over the non color changing bracket bonding adhesives as these materials save clinical chairside time because of their color changing property which helps in easy flash removal while bonding brackets.

A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant Connecting Bar

The most frequent mechanical complications of the bar-implant-retained overdentures are loosening of the bar screws and the need to reactivate the retentive clips. This article describes a technique to construct a new maxillary overdenture to a nonretrievable round-profile implant connecting bar with 2 distally placed attachments. The retainer round-profile bar was nonretrievable due to a worn retaining screw head. Attachment transfer analogs are used to transfer the position of the attachments to the master cast. The technique allows the clinician to construct new overdentures without the need for removal of the implant connecting bar. Reduced chairside time, reduced treatment cost, and increased patient satisfaction are the major advantages of the technique.

A Comparison of Frictional Resistance between Active and Passive Self-ligating Brackets with Conventional Bracket Systems

ABSTRACT Friction, though, is an inseparable and undeniable orthodontic entity that should be minimized, if not eliminated, for obtaining an optimal biological tissue response. Aim The present study compared the frictional resistance of active (time- 2, In-Ovation R) and passive (Damon SL-2, Smart clip) self-ligating brackets with conventional titanium, fiberglass and ceramic brackets under dry and wet conditions with artificial saliva using universal testing machine. Methods Modified Tidy's jig was constructed to simulate clinical situation. A total of 200 samples were tested. Specimens were divided into two categories which were run under dry and wet conditions, using artificial saliva. Around 10 samples of each active and passive selfligating brackets were dry run and 10 others were used in wet conditions. Around 10 samples of each ceramic, titanium and fiberglass brackets were run using elastomeric ties in both dry and wet conditions and 10 each of them using stainless steel ligatures under dry and wet conditions. Results The study revealed that the least frictional resistance was demonstrated by the brackets in the following order, i.e. passive selfligating brackets, active self-ligating brackets, titanium, fiberglass and ceramic brackets in both dry and wet conditions. Conclusion The self-ligating brackets seem to be promising in quenching the thirst of orthodontist to have a bracket that is functionally efficient with reduced friction, esthetically pleasing, reduced treatment and chairside time, combined with better oral hygiene maintenance and patient comfort because of absence of ligation.

Frictional characteristics of the newer orthodontic elastomeric ligatures

Elastomeric ligatures reduce chairside time but increase friction. Polymeric coatings and 45° angulations have been introduced to the ligature modules to combat its disadvantages and reduce friction. This in vitro study compared the frictional characteristics of six different types of the most commonly used elastomeric modules. Thecoefficient of friction for six ligation methods: the non-coated Mini Stix† and coated Super Slick Mini Stix (TP Orthodontics), 45° angulated but non-coated Alastik Easy-To-Tie (3M Unitek) elastomerics and non-angulated non-coated Alastik QuiK-StiK FNx01 , 0.110'- and 0.120'-diameter elastomerics (Reliance Orthodontics) were measured in dry conditions utilizing a jig according to the protocol of Tidy. A significant difference was observed between the various types of elastomeric ligatures (P<.01). Among the six types of elastomeric ligatures, the 45° angulated elastomeric ligatures produced the least friction, followed by the coated Super Slick elastomers. No difference in the friction was noted when the diameter of the elastomeric ligatures was varied. Polymeric surface coatings and introduction of angulations into elastomeric ligatures reduce the friction during sliding; however, the diameter of the ligature made no difference to sliding friction.

Dental rehabilitation of amelogenesis imperfecta using thermoformed templates

Amelogenesis imperfecta represents a group of dental developmental conditions that are genomic in origin. Hypoplastic AI, hypomineralised AI or both in combination were the most common types seen clinically. This paper describes oral rehabilitation of a 9-year-old Malay girl with inherited hypoplastic AI using transparent thermoforming templates. The defective surface areas were reconstructed to their original dimensions on stone cast models of the upper and lower arches using composite, and transparent thermoform templates were fabricated on the models. The templates were used as crown formers to reconstruct the defective teeth clinically using esthetically matching composite. The usage of the templates allowed direct light curing of the composite, accurate reproducibility of the anatomic contours of the defective teeth, reduced chair-side time and easy contouring and placement of homogenous thickness of composite in otherwise inaccessible sites of the affected teeth.

Custom Copings for Accurate Impressions of Multiple Internal Connection Implants

The technique presented facilitates a 1-step final impression and registration of multiple internal connection implants that have an unfavorable proximity. This is achieved by the use of customized impression elements that provide an accurate registration of the implant positions and the maxillomandibular relation. By means of this procedure, problematic implant positions are bypassed and chair-side time is reduced significantly.

Estimating determinants of dentist productivity: new evidence.

Productivity (output per unit of input) is a major driver of dental service capacity. This study uses 2006-2007 data to update available knowledge on dentist productivity. In 2006-2007, the authors surveyed 1,604 Oregon general dentists regarding-hours worked, practice size, payment and patient mix, prices, dentist visits, and dentist characteristics. Effects of practice inputs and other independent variables on productivity were estimated by multiple regression and path analysis. The survey response rate was 55.2 percent. Dentists responding to the productivity-related questions were similar to dentists in the overall sampling frame and nationwide. Visits per week are significantly positively related to dentist hours worked, number of assistants, hygienists, and number of operatories. Dentist ownership status, years of experience, and percentage of Medicaid patients are significantly positively related to practice output. The contributions of dentist chairside time and assistants to additional output are smaller for owners, but the number of additional dentist visits enabled by more hygienists is larger for owners. As in earlier studies of dental productivity, the key determinant of dentist output is the dentist's own chairside time. The incremental contributions of dentist time, auxiliaries, and operatories to production of dentist visits have not changed substantially over the past three decades. Future studies should focus on ultimate measures of output--oral health--and should develop more precise measures of the practice's actual utilization of auxiliaries and their skill and use of technology.

Root canal treatment using thermoplasticized carrier condensation technique

Background: The management of pulpally and apically infected teeth has evolved into a modality of conservation with predictable degree of success. Root canal treatmentoften requiresprotracted chairside time. A new technique involving placement of thermoplasticized core carrier obturators was compared with conventional lateral condensation technique. Methods: A prospective, comparative, in-vivo cohort study was carried out on randomly selected 100 patients visiting a tertiary care centre from July 2005 to July 2007, for primary, non-surgical conservative management of teeth requiring root canal treatment. Two groups of fifty cases each were managed withlateral condensation and thermoplasticized core carrier obturation techniques. Outcome variables were rate of obturation and failure rates as assessed by clinical and radiological evaluation. Result: The time taken in case of lateral condensation of maxillary central incisor was 17.30 ± 3.373 minutes and 28.07 ± 2.586 minutes in case of mandibular molar. In the thermoplasticized carrier condensation technique, for the central incisors it took 13.00 ± 1.376 minutes and 21.07 ± 2.463 minutes for mandibular molars. The mean rank value for time taken for obturation as per Mann Whitney U test (p < 0.01) were 27.88 for maxillary incisor and 44.73 for mandibular molar in the lateral condensation technique and 13.13 and 16.27 respectively for thermoplasticized gutta percha carrier condensation. The values were statistically significant. With 16% and 14% cases having unsatisfactory filling as evaluatedby post filling radiograph, Chi square test two tailed p value was 0.6836 and there was no statistically significantdifference between the two groups. An absolute failure rate of 10% was seen in lateral condensation group and 6% in thermo-plasticized carrier condensation group. Fisher exact 2-tailed p value was 0.71 and the difference in failure rate was not statistically significant. Conclusion: Root canal obturation by thermoplasticized core carrier condensation technique is an effective alternative to conventional lateral condensation technique in terms of quick and successful outcome.

The Efficacy of a Modified Omega Wire Extension for the Treatment of Severely Damaged Primary Anterior Teeth

The restoration of the severely damaged anterior teeth is considered a serious challenge in contemporary dental practice. The aim of the present study was the clinical and radiographic evaluation of a modified omega loop technique for the restoration of the severely damaged primary anterior teeth. A total of 144 anterior teeth in 60 healthy children (male: 32, female: 28) aged 3-4 years, severely damaged by dental caries, were included in the present study. The root canal therapy was performed for the selected teeth. After the construction of the modified omega loop, coronal 4 mm of intracanal ZOE was removed. A thin layer of polycarboxylate cement was placed over ZOE followed by the insertion of the modified omega loop and subsequent restoration of the crown with an internal compomer core and an external composite restoration. The patients were followed at the intervals of 6, 12, and 24 months postoperatively. The partial loss of the restorative material after 6 months occurred in 5.9% of the teeth. The failure rates after 12 and 24 months were 10.8% and 18.5%, respectively. The primary canines exhibited minimum loss of the restorative material. Two teeth exhibited pathological mobility after two years. There were not any signs of root fracture or recurrent caries in any of the restored teeth. It may be concluded that the modified omega loop is an efficient technique for the restoration of the severely damaged anterior teeth. The ease of manipulation and short chair-side time are further advantages of the technique.

Modifications to increase efficiency of the begg orthodontic technique

Background: Orthodontic appliances that deliver results in a shorter time period without sacrificing the quality of the outcome are preferred. A modified fixed appliance, blending the merits of the Preadjusted Edgewise and Begg appliances was tested. Methods: Thirty patients each were randomly assigned for treatment with one of the three fixed appliance techniques after qualifying for the inclusion and exclusion criteria established before the study. Peer assessment rating (PAR) index was used to compare the quality of treated cases. Total time as well as chairside time taken for treatment with the three techniques was also compared. ANOVA and paired student ‘t’ test were used for statistical analysis. Result: There was a significant reduction in PAR scores with all the three appliances. There was no significant difference in the quality of treatment outcome between the Preadjusted Edgewise appliance (PEA) and the modified Begg appliance. These appliances gave a significantly better improvement as compared to the Begg appliance. Chairside and total time taken was the least with the modified Begg appliance followed by the PEA and Begg appliances. Conclusion: The suggested modification of the Begg appliance is efficient and economical as compared to PEA and Begg appliances in the treatment of cases with anterior teeth proclination as one of the elements of malocclusion.

A combined chemo-mechanical approach for aesthetic management of superficial enamel defects

The aim of this article is to describe an easy technique for managing small superficial defects in light to medium fluorosis. The proposed technique is based on a selective abrasion of the superficial enamel and a recreation of the superficial macro and micro morphology. The aesthetic appearance can be enhanced by power or home bleaching. The presented technique can manage enamel defects which are confined in the most external enamel surface with satisfying aesthetic results. This conservative approach may be considered an interesting alternative to more invasive prosthetic techniques based on composite reconstructions or ceramic veneers, minimising invasivity, chairside time and costs for patients.

HOME BLEACHING TECHNIQUE USING CARBAMIDE PEROXIDE

There are two basic kinds of tooth whitening agents. The first is over the counter materials and the other is material used by the dentist or under dentist control. Home bleaching is a technique using 10% carbamide peroxide on a tray applied by patient under dentist supervision. This paper is a review of the effect of 10% carbamide peroxide home bleaching technique. It is revealed that this method is simple, safe, economic, and has short chairside time.

Self-Ligating Brackets in Lingual Orthodontics

Self-ligating brackets have important benefits that may contribute to the efficiency of lingual orthodontic treatment: reduced friction and faster alignment, improved oral hygiene, improved clinical efficiency, and time saving. These attributes of self-ligating brackets address the main difficulties of the lingual technique. The different self-ligating brackets used for lingual orthodontics are discussed as well as bracket positioning techniques. Two patient examples treated with the Adenta Evolution (Adenta GmbH, Gliching, Germany) brackets demonstrate the potential of self-ligating brackets to improve and simplify the lingual technique, reducing the treatment time, chairside time, and the mechanical difficulties. Patient comfort with the self-ligating lingual brackets has still to be improved.

Cruise Medicine: The Dental Perspective on Health Care for Passengers During a World Cruise

Although more than 100 million passengers have taken a cruise since 1980, it is not known what dental treatment needs occur at sea. The routine dental documentation of a 2-month period at sea on a cruise ship carrying 1,619 passengers was analyzed. The subjects for the study were 57 passengers (3.5% of 1,619), with a mean age of 71 years (+/-9.8 y). Age, gender, number of natural teeth and implants, prosthetic status, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment, time since last visit to the dentist, and cabin category as indicator of socioeconomic status were extracted. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile. Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Emergency dental treatment accounted for 97% of the chairside time. The three most frequent emergency diagnoses were defective restorations (36%), pulpal disease (20%), and defective prosthesis and caries (both 11.5%). Common emergency therapies provided were complex surgical-prosthodontic rehabilitation, various endodontic treatments, and extractions. Per 1,000 persons/month, passengers required 21.6 emergency plus 2.5 routine appointments; 49% of passengers had seen a dentist within 3 months before going to sea. Passengers do attend their dentist for routine care/checkups before the voyage, yet experience complex dental emergencies. This is due to the presence of a high number of restorations that fail unexpectedly. Some failures are so severe that they would have forced the passenger to abort the cruise had there been no dental service available. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterized by OHRQoL scores.

Technical complications of implant‐supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years

The purpose of this prospective long-term study was to evaluate the incidence of the most common technical problems, namely screw loosening, screw fracture, fracturing of veneering porcelain and framework fracture in implant-supported fixed partial dentures (FPDs), and assess the survival and success rate (event-free survival) after 5 years of function. In 76 partially edentulous patients, a total of 205 3i-implants (machined surface) were placed and restored with 112 implant-supported FPDs (46 single crowns, 81 splinted crowns, seven FPD bridges and 23 FPDs with cantilevers). The survival rate of FPDs supported by implants was 94.5% (CI-95: 90.1-98.8) after an average observation period of 5 years. The success rate (event-free survival) of the FPDs was 80% (CI-95: 87.3-72.7). After an observation period of 5 years the cumulative incidence of screw loosening was 6.7% (CI-95: 1.8-11.5), the cumulative incidence for screw fracture was 3.9% (CI-95: 0.1-7.7). Fracture of the veneering porcelain occurred in 5.7% (CI-95: 1.2-10.2) of all FPDs. Fracturing of the suprastructure framework was rare (1%; CI-95: 0-2.9). The overall complication incidence after 5 years was highest in the group of FPDs with cantilever, which showed the lowest success rate 68.6% (CI-95: 50-87.3), followed by single crowns (77.6%; CI-95: 53.3-100) and splinted crowns (86.1%; CI-95: 59.5-100). No complication occurred in FPD bridges. Fixed partial dentures supported by 3i-implants showed low technical complications rates, the most common being loosening of the abutment screw. Managing these complications can cause extra amount of chair-side time and patient dissatisfaction.