Long and short term management of implant-supported mandibular overdentures.

UNLABELLED: Common problems with the long term clinical use of implant-supported mandibular overdentures (ISMDs) include fractures of dentures, bars and clips, and reactivation of clips. Many general dental practitioners (GDPs) are reticent to be involved in the maintenance of ISMDs, especially if they have not had any further training or are unfamiliar with implant components and systems. This article highlights the need for the training of GDPs in maintenance and management of ISMDs as an increasing number of edentulous patients are being provided with ISMDs, resulting in an increasing need for the maintenance of the prosthesis in the primary care setting at a possible cost to the patient. CLINICAL RELEVANCE: Implant-supported overdentures are becoming a common treatment option for edentulous patients, however, they are not without their clinical challenges, many of which can be easily rectified in a primary care environment, such as general practice.

Sectional dentures revisited.

UNLABELLED: Sectional dentures are constructed in separate parts which join together intra-orally to create a single prosthesis. They are used to exploit undercuts around teeth, hard and soft tissues which require more than one path of insertion, and are usually of split pin or locking bolts design. By using two case studies, we aim to illustrate the provision of sectional dentures and to which situations their uses are best suited. A 30-year-old male was referred to the Department of Prosthetics at the Birmingham Dental Hospital for a replacement upper partial cobalt chrome denture of a Kennedy Class IV bounded saddle. The patient had a history of failed upper cobalt chrome removable partial dentures owing to loss of retention and poor stability over the previous 12 months. A 40-year-old female patient was referred by her GDP for restoration of a bounded saddle in the lower right quadrant with a history of intolerance to previous dentures. These two cases demonstrate the successful use of sectional dentures in the aesthetic zone. Although more technically demanding, they lie well within the scope of general practice and offer patients alternative solutions from dental implants and bridgework. These cases highlight the importance of the use of alternative prosthetic techniques which can be simple and achievable for all practitioners. CLINICAL RELEVANCE: Sectional dentures are a treatment modality for the edentulous space where the presence of one or more undercuts prevents restoration by more conventional techniques. This paper highlights some of the situations in which sectional dentures can be employed and emphasizes their use in general practice.

Management of periodontal disease in general dental practice.

UNLABELLED: This paper reviews the important parameters deemed useful in the diagnosis and management of periodontal disease in general dental practice. We aim to highlight the importance of these when making a diagnosis and the necessary treatment undertaken in general dental practice before considering referral to specialist services. We also provide guidelines to assist the referral of patients for periodontal treatment in specialist care settings. CLINICAL RELEVANCE: This paper provides the knowledge base to facilitate correct management of periodontal disease in dental practice.

Principles of crown lengthening surgery.

UNLABELLED: Crown lengthening is an invaluable tool for the restorative dentist in the management of short clinical crown heights. This procedure, as an adjunct to a holistic restorative treatment plan, can produce predictable results, whilst ensuring good aesthetics and maintaining periodontal health. Crown lengthening procedures are invaluable where toothwear or lack of supragingival tooth substance would render full coverage restoration difficult. Gaining access to subgingival caries for strategic abutments can also be achieved in this way. In certain instances, excessive gingival show or inharmonious gingival margin levels can be aesthetically managed with crown lengthening procedures. CLINICAL RELEVANCE: Knowledge of crown lengthening techniques, and where these might be prescribed, may be a useful addition to practitioners' treatment planning options, or to decide when referral may be more appropriate.

Optimising volumetric arc radiotherapy for dental rehabilitation in oropharynx cancer - A retrospective dosimetry review and feasibility planning study.

PURPOSE: To assess the dosimetry to dentally relevant substructures within the mandible/maxilla, establish the predictors of increased mean anterior mandible dose and assess the feasibility of rationale optimisation of dose to the anterior mandible (AM) volume to aid reconstructive dental surgery planning, where the AM is a critical structure. MATERIALS AND METHODS: In a cohort of radically treated oropharynx cancer patients we conducted a retrospective dosimetry analysis of mandible/maxilla volumes, created using a published atlas. Comparisons of mean AM dose and clinical parameters between groups were tested using Wilcoxon rank-sum and Kruskal-Wallis tests. A multivariate linear regression model was created to assess independent predictors of increased mean AM dose. Patients with a mean AM dose over 37.5 Gy were included in feasibility planning study to test the hypothesis that it is possible to safely limit the dose whilst maintaining dose tolerances for other organs at risk. RESULTS: 57 patients were included. Median AM mean dose was 32.2 Gy (IQR 27.7-38.7). T stage, N stage and inclusion of Level 1B were significantly associated with increased mean AM dose. Only T stage (p = .0132) and Level Ib inclusion (p = .018) remained significant in the linear regression model. 88% of plans, all of which included Level Ib, were successfully re-optimised without breaching accepted constraints. CONCLUSIONS: Oropharynx cancer patients with advanced T stage and who require Level Ib treatment receive increased mean AM dose, potentially limiting surgical dental rehabilitation options. The majority of patients can be optimised safely with appropriate AM contouring.