Recall Visits Research Articles

Immediate Versus Conventional Loading for the Maxilla with Implants Placed into Fresh and Healed Extraction Sites to Support a Full-Arch Fixed Prosthesis: Nonrandomized Controlled Clinical Study

To compare immediate and conventional loading of fixed full-arch maxillary prostheses supported by implants placed in healed and fresh postextraction sites. This prospective, controlled, nonrandomized 12-month study included 30 consecutive patients requiring fixed full-arch maxillary prostheses supported by implants placed in healed and fresh extraction sites. Fifteen patients were treated with conventional loading (control group), and 15 were treated with immediate loading (test group). Each patient received six to eight implants; implants with insertion torque < 35 Ncm were conventionally loaded and excluded from the analysis. Implant success, biologic and prosthetic complications, success of the immediately loaded provisional prostheses, and marginal bone loss were assessed and analyzed statistically. One test group patient failed to attend recall visits and was excluded from the study, and 16 implants did not achieve insertion torque of 35 Ncm and were excluded from analyses. The final sample included 29 patients and 193 implants (94 test implants, 99 control implants). Implant success rates were 96.8% (test) and 99.0% (control). In the test group, the most common complications were screw loosening and tooth fractures; in the control group, dentures caused discomfort and soft tissue irritation. The success rate of the immediately loaded prostheses was 100%. Average bone loss was 0.61 ± 0.21 mm for test implants and 0.53 ± 0.18 mm for control implants. Differences between loading protocols were not statistically significant. No significant differences in implant success and peri-implant marginal bone loss were seen in the current 12-month comparison of immediate and conventional loading of maxillary fixed full-arch prostheses. Biologic and prosthetic complications were rare with both loading protocols, and all immediately loaded provisional fixed prostheses performed successfully.

Oral manifestations and dental management of a child with Zellweger syndrome

Zellweger syndrome (ZS) is a rare autosomal recessive disorder, resulting from an impairment in peroxisome function. It is characterized by craniofacial dysmorphism and neurological abnormalities, and involves several systems, which may complicate dental and anesthesia management. The case of a 7-year-old girl diagnosed with ZS is described with emphasis on oral manifestations, oral rehabilitation under general anesthesia (GA), and home oral care. Apart from the unique features of ZS, she presented with clinodactyly, distinctive palatal vault, Class III malocclusion, missing teeth, microdontia, and delayed dental formation. Dental treatment under GA was conducted with concerns of risk of respiratory insufficiency. Oral home care by the parent and regular recall visits were essential to maintain good oral health. Children with ZS may survive into late childhood. They, however, present multiple health problems that are of special concern for not only the pediatric dentist but also the anesthesiologist. Collaboration with the medical team is essential for optimal care of these patients.

Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel

The authors conducted a study to evaluate tooth sensitivity (TS) and the bleaching effectiveness associated with use of a calcium-containing (CC) in-office bleaching gel. The authors used a 35 percent calcium-free (CF) hydrogen peroxide gel and a 35 percent CC hydrogen peroxide gel according to the manufacturer's instructions in 40 caries-free participants 18 years or older. They performed two bleaching sessions with a one-week interval between sessions. The authors registered the color at baseline and after the first and second bleaching sessions by using a shade guide and by gauging the participant's perception of TS as registered on a scale from 0 (none) to 4 (severe). The authors evaluated the bleaching effectiveness at each week's recall visit by means of the Friedman test, and they compared the groups at each assessment point by means of the Mann-Whitney test. They evaluated the percentage of participants with TS and the intensity of the TS by using the Fisher exact and Mann-Whitney tests. Both groups demonstrated equivalent and significant tooth color enhancement compared with color values at baseline (P < .05), with an average bleaching of 7 to 8 shade guide units. Most of the participants from the CF group (80 percent) experienced sensitivity while undergoing the bleaching regimen, whereas only 40 percent of participants from the CC group reported experiencing TS (P = .02). The intensity of TS was significantly higher (P < .01) for the CF group during in-office dental bleaching. The CC 35 percent hydrogen peroxide gel reduced the TS during in-office dental bleaching without jeopardizing the bleaching effectiveness. The results of this study support the findings that a CC 35 percent hydrogen peroxide gel can reduce TS during in-office dental bleaching.

Onychophagia and postorthodontic isolated gingival recession: Diagnosis and treatment

This clinical report describes the diagnosis and the management of isolated-type recession defects of complex etiology in 2 healthy postorthodontic patients. The lesions were confined to 1 mandibular incisor and were associated with an abnormal buccolingual inclination of the affected tooth despite a lingual retainer made with a round stainless steel twisted wire. After careful questioning, it was determined that the recession defects were indirect effects of habitual onychophagia. The concomitant fingernail-biting habit and the lingual bonded retainer led to the indirect development of bone dehiscence and, consequently, gingival recession.

The relationship between nurses’ oral hygiene and the mouth care of their patients

To investigate the extent to which a relationship may exist between nurses' own oral hygiene and their commitment and capability of following instructions for tooth brushing with conventional and triple-headed toothbrushes, to cerebral palsy (CP) children. The study included 43 individuals with CP and their 44 nurses. A structured questionnaire was designed to assess I. Demographic characteristics of the nurses II. Nurses' knowledge and maintenance of their own oral-hygiene and that of their CP patients. Nurses' ability to follow instruction for tooth-brushing was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing, as well as on a recall visit one month later. More nurses (72.7%) reported routine tooth-brushing in the morning than in the evening (40.9%). Most nurses (73%) reported not flossing their teeth at all, and more than half reported visiting their dentist only when they suffer pain. A positive correlation was found between the nurses' knowledge of preventive oral measures and their compliance with their own oral hygiene and with that of their CP patients. Similarly, a positive correlation was found between nurses' receiving previous instruction for correct oral hygiene and their maintenance of their patients' oral hygiene. Institutions for CP patients should disseminate information on oral hygiene to staff, as a means of increasing their maintenance of their patients' oral health.

The effect of toothbrush design on the ability of nurses to brush the teeth of institutionalized cerebral palsy patients

To compare the effectiveness of two toothbrush designs in tooth brushing by nurses of individuals with cerebral palsy. Following instruction, nurses brushed the teeth of 21 individuals with a single-headed-toothbrush, and 22 with a triple-headed-toothbrush. After one month, the nurses brushed their patients with the other toothbrush, following instruction. Tooth brushing performance skill was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing as well as on a recall visit one month later. After 1 month, 7.6% of the nurses required further instruction following brushing with the triple-headed toothbrush compared to 15% after brushing with the single-headed. Reductions in plaque and gingival indices were greater after using the triple- headed than single-headed toothbrush. More nurses preferred the triple-headed toothbrush (75.5% compared to 22.6%). Brushing by nurses of cerebral palsy patients was more effective and instruction better retained with a triple-headed compared to single-headed toothbrush.

Management of generalized attrition with an overlay removable partial denture for restoration of the OVD–a new treatment option

Overlay removable partial denture can be used as an interim prosthesis for the patients who have lost their occlusal vertical dimension due to moderate to severe attrition resulting in functional and esthetic problems. This prosthesis is believed to allow neuromuscular adjustments to a newly adjusted VDO and also to observe the function and esthetics. ORPDs provide reversible and relatively inexpensive treatment for the patients who have limitations. In this case report, a patient was treated with overlay removable partial denture for restoring the lost vertical dimension. This article reviews indication, advantage, disadvantages of ORPDs. Though there are esthetic and functional limitations with potential risk of material fracture, all patients with severely worn dentition with decreased VDO and missing teeth should be offered this treatment option. Regular recall and maintenance visit are essential for long term success of ORPDs.DOI: http://dx.doi.org/10.3329/cdcj.v9i1.11834 City Dental College Journal Vol.9(1) 2012 23-27

Economic Impact of Dental Hygienists on Solo Dental Practices

The fact that a significant percentage of dentists employ dental hygienists raises an important question: Are dental practices that utilize a dental hygienist structurally and operationally different from practices that do not? This article explores differences among dental practices that operate with and without dental hygienists. Using data from the American Dental Association's 2003 Survey of Dental Practice, a random sample survey of U.S. dentists, descriptive statistics were used to compare selected characteristics of solo general practitioners with and without dental hygienists. Multivariate regression analysis was used to estimate the effect of dental hygienists on the gross billings and net incomes of solo general practitioners. Differences in practice characteristics--such as hours spent in the practice and hours spent treating patients, wait time for a recall visit, number of operatories, square feet of office space, net income, and gross billings--were found between solo general practitioners who had dental hygienists and those who did not. Solo general practitioners with dental hygienists had higher gross billings. Higher gross billings would be expected, as would higher expenses. However, net incomes of those with dental hygienists were also higher. In contrast, the mean waiting time for a recall visit was higher among dentists who employed dental hygienists. Depending on personal preferences, availability of qualified personnel, etc., dentists who do not employ dental hygienists but have been contemplating that path may want to further research the benefits and opportunities that may be realized.

Concomitant carotid plaque development and brachial artery diameter enlargement: A retrospective, recall-based study in postmenopausal women

Background and aimTo verify if the carotid plaque development is concomitant to brachial artery diameter enlargement, in healthy postmenopausal women. Methods and resultsThis is a retrospective, recall study. We enrolled 40 postmenopausal women, selected from a database for the period 2000–2008, not affected by subclinical carotid atherosclerosis and without risk factors for cardiovascular disease. At the recall visit, carotid and brachial duplex scan was again obtained.The incidence of plaque was 30% after a mean follow-up period of 60 months. There were no differences in baseline characteristics between subjects developing carotid atherosclerosis and subjects who did not, except for the brachial diameter change, follow-up and heart rate. The logistic-regression analysis confirmed that only brachial diameter change resulted to be correlated with the development of carotid atherosclerosis. ConclusionBrachial artery diameter increase is concomitant to carotid plaque development. Vascular enlargement could not be a focal change but a systemic process associated with atherosclerotic plaque development. Brachial diameter could be a tool with a predictive significance.

The survival of Class V restorations in general dental practice: part 3, five-year survival

To evaluate the survival over five years of Class V restorations placed by UK general practitioners, and to identify factors associated with increased longevity. Prospective longitudinal cohort multi-centre study. UK general dental practices. Ten general dental practitioners each placed 100 Class V restorations of varying sizes, using a range of materials and recorded selected clinical information at placement and recall visits. After five years the data were analysed using the Kaplan-Meier method, log-rank tests and Cox regressions models to identify significant associations between the time to restoration failure and different clinical factors. After five years 275/989 restorations had failed (27.8%), with 116 (11.7%) lost to follow-up. Cox regression analysis identified that, in combination, the practitioner, patient age, cavity size, moisture contamination and cavity preparation were found to influence the survival of the restorations. At least 60.5% of the restorations survived for five years. The time to failure of Class V restorations placed by this group of dentists was reduced in association with the individual practitioner, smaller cavities, glass ionomer restorations, cavities which had not been prepared with a bur, moisture contamination, increasing patient age, cavities confined to dentine and non-carious cavities.

Similar caries pattern in monozygotic twins: Role of nature and/or nurture

AbstractThe present article attempts to relook at the role of genetics in the caries pattern in pediatric patients. Genetics exerts a major influence on initiation and progression of caries. Several investigators have studied the genetic aspects in humans using both twin studies and family pedigree approaches. The recent advances in molecular biology and the outcomes of the Human Genome Project can help to have innovative approaches to understand the etiology of this complex disease. A pair of 5-year-old monozygotic twin brothers was referred by the Pediatrician for multiple caries. Both the brothers were reared apart but presented with similar dental caries traits. Comprehensive oral health care with a preventive and therapeutic procedure was provided. Periodic recall visits were scheduled after every 6 months. By studying dental diseases in the twins reared apart, the element of environmental influence is eliminated while retaining the advantage of similar genotype in monozygotic twins. This report of monozygotic twins imparts light on the significant contribution of genetic factors on caries susceptibility.

Retention of People Living with HIV/AIDS in Oral Health Care

We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes. We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care. In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums. Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.

Fabrication of custom made eye prosthesis for anophthalmic paediatric patients: 2 case reports

The loss of an eye is an emotional and psychological setback to the patient. After enucleation, evisceration or exenteration of the eye, the goal is to replace the missing tissues with an artificial prosthesis and restore the facial symmetry and normal appearance of the anophthalmic patient. In case of pediatric patients, the team approach of the ophthalmologist, the maxillofacial prosthodontist and pedodontist are required to rehabilitate the ocular defect, that improves not only the patient's comfort and cosmesis as well as maintain the near symmetrical bony orbital wall and eyelid development. This article illustrates two different cases of pediatric patients where the eye was surgically removed and ocular prosthesis was fabricated.Clinical Relevance to Interdisciplinary Dentistry A few case reports are mentioned in literature for prosthetic rehabilitation of anophthalmic pediatric patients. The presented case reports stressed the use of custom made eye prosthesis than prefabricated one for pediatric patients. As patient grows, the size of eye socket changes, hence periodic enlargement of the prosthesis is necessary for a growing child to aid in the normal development of the lids and the soft tissue lining the orbital bone. The custom made prosthesis can be adjusted whether needed at recall visits. The presented technique is simple and less time consuming. This technique is least depended upon artistic ability of dentist.

Type III apical transportation of root canal

Procedural accidents leading to complications such as canal transportation have been ascribed to inapt cleaning and shaping concepts. Canal transportation is an undesirable deviation from the natural canal path. Herewith a case of apical transportation of root canal resulting in endodontic retreatment failure and its management is presented. A healthy 21-year-old young male presented discomfort and swelling associated with painful endodontically retreated maxillary incisor. Radiograph revealed periradicular radiolucency involving underfilled 11 and overfilled 12. Insufficiently obturated 11 exhibited apical transportation of canal. This type III transportation was treated by periradicular surgery and repair using white mineral trioxide aggregate (MTA). Comfortable asymptomatic patient presented uneventful healing at third and fourth month recall visits. A decrease in the size of radiolucency in radiograph supported the clinical finding. In the present case, MTA is useful in repairing the transportation defect. The result of these procedures is predictable and successful.

Hereditary gingival fibromatosis

Hereditary gingival fibromatosis is a rare benign oral condition characterised by slow and progressive enlargement of both maxillary and mandibular attached gingiva. It may develop as an isolated disorder but can feature along with a syndrome. A case of 12 year old female child who presented with generalised severe gingival overgrowth, involving both the arches and covering almost the entire dentition, and had all the teeth remaining invisible within the confinement of gingival tissues. The excess gingival tissue, in this non-syndromic case was removed by conventional gingivectomy using local as well as general anaesthesia. The post-operative result was uneventful and the patient appearance improved considerably. Good aesthetic result was achieved to allow patient to practice oral hygiene measures. After treatment regular recall visits are necessary in order to evaluate oral hygiene and stability of periodontal treatment.

An unusual presentation of peripheral buttressing bone in anterior maxilla: Case report and management

The phenomenon of buttressing bone formation is relatively uncommon in the alveolar bone, more so in the anterior maxilla. In our case, peripheral buttressing bone formation presented as an isolated hard gingival swelling with relation to 21 in a 14-year-old girl. Radiographic presentation was normal with no evidence of bone loss or altered bone density. Therefore explorative surgery was planned. Buttressing bone formation could be appreciated, which also was the cause for swelling clinically. Osteoplasty was done and bone graft placed in the defect. On a subsequent recall visit gingivoplasty was done to reduce gingival thickness to improve esthetics. We report the case for its unusual presentation, its management with follow-up.

Breast cancer worry in further examination of mammography screening – a systematic review

In this systematic review, we explored which factors are associated with breast cancer (BC) worry in further examination (FE) of mammography screening and for how long women experience BC worry associated with FE. Medline, Cochrane, Cinahl and the International Network of Agencies for Health Technology Assessment databases were used in the search. In addition to this, reference lists of the selected articles were inspected. The subject headings and keywords searched included breast screening, mammography screening, BC worry, distress or anxiety, additional test, further examination and recall. These were used separately and in combination. The databases gave 598 references. From the selected titles, 83 abstracts were read; from these, 23 publications were selected for full-text review. On the basis of full texts, 15 articles were chosen. There were very few studies about the associations between FE and BC worry. In those found, the amount of measured variables was limited. BC worry in FE of breast screening was associated with several sociodemographic and psychosocial factors of recalled women, as well as those related to the FE process. About half of the recalled women were quite or very anxious in the prediagnostic phase. The review gave implications for interventions in the FE process of mammography screening. These interventions should predominantly be made in the preclinical phase and should differ according to the type of recall visit and characteristics of recalled women. In communicating the diagnosis to the women, the time from the examination process to diagnosis should be as short as possible, and in addition to physicians being present, other health care professionals should also be there to ensure the necessary emotional and practical support a woman needs in such a situation.

Fluoride varnish may improve white spot lesions

A randomised, parallel-group, controlled clinical trial. The test group had fluoride varnish applied onto the tooth surfaces with WSLs using a miniature cotton swab or brush and advised not to brush for four hours. The control group had saline solution applied. Status of the WSLs were assessed using a DIAGNOdent pen (KaVo, Biberach, Germany). Of the 110 participants recruited, 14 dropped out between the debonding and the six-month recall visit. There were statistically significant differences between the mean DIAGNOdent readings of the two groups at the three-month (P<0.05) and at the six-month follow-up visits (P<0.01). No adverse response or safety concerns in the use of fluoride varnish were reported by any of the subjects. A greater decrease in DIAGNOdent pen readings was found in the test group during the first six months after debonding. This may be taken to imply an improvement in the WSLs. Thus, topical fluoride varnish application appears to be a good method to treat WSLs and should be advocated as a routine measure after orthodontic treatment.

Alternative treatments to replacement of defective amalgam restorations: Results of a seven-year clinical study

The authors conducted a prospective cohort clinical study to investigate the effectiveness of alternative treatments to the replacement of defective amalgam restorations. Fifty patients aged 21 through 77 years (mean age, 56 years) with 113 defective amalgam restorations that were diagnosed during treatment planning participated in the study. The authors assigned each tooth to one of five treatment groups: repair with amalgam (n = 20), sealing of defective margins (n = 23), refinishing (n = 23), replacement (n = 22) or no treatment (n = 25). The replacement and no-treatment groups served as comparison groups, and the authors assigned 47 teeth randomly to these groups. Two clinicians examined the restorations before and after the assigned treatment and at subsequent recall visits by using modified U.S. Public Health Service criteria including marginal adaptation, anatomic form, occlusal and proximal contact, postoperative sensitivity and secondary caries. The clinicians examined 94 restorations (83 percent) at the one-year recall visit, 74 (65 percent) at the two-year recall visit and 54 (48 percent) at the seven-year recall visit. They observed most of the downgraded and failed restorations after the first two years of clinical service. The study results show that some degree of degradation occurred in all treatment groups, including the replacement group, at the seven-year recall examination, with no significant failure rate. The results support the repair of defective amalgam restorations as an alternative to replacement. Furthermore, the study findings show that in future controlled clinical trials, all teeth may receive random assignment. The study findings support repair rather than replacement of amalgam restorations with localized defects. Randomized controlled trials are needed to confirm these findings.

The survival of Class V restorations in general dental practice. Part 2, early failure

To evaluate Class V restorations placed by UK general practitioners comparing those failing or surviving after two years, and to identify factors associated with early failure. Prospective longitudinal cohort multi-centre study. Setting UK general dental practices. Ten dentists each placed 100 Class V restorations and recorded selected clinical information at placement and recall visits. Univariate associations were assessed between recorded clinical factors and whether restorations had failed or not at two years. Multi-variable binary logistic regression was also undertaken to identify which combination of factors had a significant effect on the probability of early failure. At two years, 156 of 989 restorations had failed (15.8%), with 40 (4%) lost to follow-up. Univariate analysis showed a significant association between restoration failure and increasing patient age, payment method, the treating practitioner, non-carious cavities, cavities involving enamel and dentine, cavity preparation and restoration material. Multi-variable analysis indicated a higher probability of early failure associated with the practitioner, older patients, glass ionomer and flowable composite, bur-preparation and moisture contamination. Among these practitioners, both analytic methods identified significant associations between early failure of Class V restorations and the practitioner, cavity preparation method, restoration material and patient's age.