Use of an obturator with nCPAP in a premature infant with a cleft lip and palate.

Premature infants have underdeveloped lungs and their care involves the use of nasal continuous positive airway pressure (nCPAP). For an adequate amount of oxygen to enter the lungs, the palate needs to be intact. Premature infants with a cleft lip and palate remain intubated for extended periods of time with the risks inherent in long-term intubation because of the inability to maintain nCPAP. This paper describes the fabrication of a custom-designed obturator attached to nCPAP variable flow generator tubing for a premature infant with a unilateral cleft lip and palate.

Three-way trays: easy to use and abuse.

The 3-way tray technique is popular as it provides master and opposing arch impressions and an interocclusal record at the same time. Excellent clinical results can be achieved with appropriate case selection, use of rigid tray and impression materials, attention to tray positioning and other details throughout the process, and clear understanding of the limitations of the technique by the operator and dental technician.

Factors affecting outcomes for single-tooth implants and endodontic restorations.

Initial root canal therapy and implant placement are both common treatment modalities, and, as such, prognostic factors that influence the treatment outcomes of these two restorations should be identified. In a retrospective chart review, 196 implant restorations and 196 matched initial nonsurgical root canal treated (NSRCT) teeth in patients were evaluated for four possible outcomes-success, survival, survival with intervention, and failure. Results showed that smokers had fewer successes and more failures in both groups (p = 0.0001), whereas NSRCT outcomes were affected by periradicular periodontitis (p = 0.001), post placement (p = 0.013), and overfilling (p = 0.003). Outcomes for both groups were not significantly affected by diabetes, age, or gender. Implant group outcomes were not affected by implant length (from 10 to 16 mm), diameter (from 3.25 to 5.5 mm), or an adjacent endodontically treated tooth, nor were NSRCT outcomes affected by the number of appointments for the procedure.

Shaping abilities of two different engine-driven rotary nickel titanium systems or stainless steel balanced-force technique in mandibular molars.

The purpose of this study was to compare apical transportation, working-length changes, and instrumentation time by using nickel-titanium (Ni-Ti) rotary file systems (crown-down method) or stainless steel hand files (balanced-force technique) in mesiobuccal canals of extracted mandibular molars. The curvature of each canal was determined and teeth placed into three equivalent groups. Group 1 was instrumented with Sequence (Brasseler USA, Savannah, GA) rotary files, group 2 with Liberator (Miltex Inc, York, PA) rotary files, and group 3 with Flex-R (Union Broach, New York, NY) files. Pre- and postoperative radiographs were superimposed to measure loss of working length and apical transportation as shown by changes in radius of curvature and the long-axis canal angle. Sequence rotary files, Liberator rotary files, and Flex-R hand files had similar effects on apical canal transportation and changes in working length, with no significant differences detected among the 3 groups. Hand instrumentation times were longer than with either Ni-Ti rotary group, whereas the rotary NiTi groups had a higher incidence of fracture.

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants.

Initial root canal treatment and the replacement of a single tooth with an implant are both viable treatment options, but various success rates have been reported for each treatment modality. This retrospective study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes: success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi2 test for association of the two classifications (endodontic vs implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.

Retrospective cross sectional comparison of initial nonsurgical endodontic treatment and single-tooth implants.

Initial root canal treatment and the replacement of a single tooth with implants are both viable treatment options, but various success rates have been reported for each treatment modality. This study compared 196 implant restorations and 196 matched initial nonsurgical root canal treatment (NSRCT) teeth in patients for four possible outcomes- success, survival, survival with subsequent treatment intervention and failure. Cross classifications/tabulations were analyzed using Pearson's chi(2) test for association of the two classifications (endo vs. implant and outcome). Polytomous regression with likelihood ratio tests were used in testing association with tooth location and outcome. Outcomes were as follows for implants and NSRCT outcomes, respectively: success 73.5% and 82.1%; survival with no intervention 2.6% and 8.2%; survival with intervention 17.9% and 3.6%; and failure 6.1% and 6.1%. Location of the restoration in the mouth did not affect outcome. This study suggests that restored endodontically treated teeth and single-tooth implant restorations have similar failure rates, although the implant group showed a longer average and median time to function and a higher incidence of postoperative complications requiring subsequent treatment intervention.

A preliminary survey of interprofessional education.

The purpose of this article is to review the literature on interprofessional education (IPE) and report on a preliminary survey of the current status of interprofessional education in seven academic health centers (AHCs) that have schools of dentistry associated with them. There is wide variability in interpretation of the term "interprofessional," and many barriers to interprofessional education exist including already overcrowded curricula in health professions schools, lack of support from faculty and administration, and financial constraints. Based on interviews completed at the authors' home institutions, it was recommended that topics such as ethics, communication skills, evidence-based practice, and informatics could be effectively taught in an interprofessional manner. Currently, some academic health centers are attempting to develop interprofessional education programs, but most of these efforts do not include dental students. Of the seven AHCs investigated in this study, only two had formal interprofessional educational activities that involved students from two or more health professions education programs. Dental school participants in this study professed a strong interest in interprofessional programs, but many interviewees from other professional schools and AHC administrators perceived that the dental school was isolated from other schools and disinterested in IPE. Many health care setting models in the future will include dentists as part of an interdisciplinary health care team; consequently, it is important for dental schools to become an active participant in future interprofessional educational initiatives.

Patient perceptions of professionalism in dentistry.

The purpose of this study was to examine how patients perceived the professionalism of University of Minnesota School of Dentistry students, faculty, and staff. Professionalism is defined by the authors as an image that will promote a successful relationship with the patient. Patients within comprehensive care clinics were asked to assess physical attributes and behaviors of the dental care providers using a questionnaire. The patients read statements dealing with characteristics of the dental care providers and responded as to whether they agreed, were neutral, or disagreed with the statement. The surveyed population consisted of 103 males and 97 females, 64 percent of whom lacked insurance coverage. Fifty-one percent of the patients were between the ages of forty-four and sixty-nine, but the overall age distribution was dispersed over a range of eighteen to one hundred. Our research found that all dental care providers displayed a professional appearance as well as behavior. The attire of the dental care provider affected the comfort and anxiety levels of patients, as did first impressions of both students and faculty. Most patients reported that students and faculty displayed effective time management and used appropriate language during the appointment. Finally, hairstyle, makeup, and jewelry appeared to have little effect on patients' opinions of the various dental care providers.

The effect of metal ceramic restoration framework design on tooth color.

STATEMENT OF PROBLEM: The opacity of the metal framework in metal ceramic restorations results in reduced light transmission through the tooth that diminishes the esthetics of the tooth. PURPOSE: The purpose of this study was to investigate the color change that occurs apically to a metal ceramic restoration as a result of altering the metal framework design. MATERIAL AND METHODS: Color change relative to the unprepared tooth (DeltaE) between various metal ceramic restorations was determined using computer imaging and CIELAB coordinates and compared to previously determined levels of clinical acceptability. Color change was evaluated by examining 2 conditions (the metal copings and the completed metal ceramic restorations), 4 framework designs (metal collar and porcelain margins with 0-mm, 1-mm, or 2-mm cutbacks), and 2 locations on the tooth apical to the margin of the restoration, using an imaging system developed at the Minnesota Dental Research Center for Biomaterials and Biomechanics. The data were analyzed statistically using repeated measures analysis of variance (P=.05). RESULTS: For metal ceramic restorations there exists a significant (P=.001) color change (DeltaE) between all framework designs except for the 0-mm and 1-mm cutbacks. Color change (DeltaE) in the location above the cemento-enamel junction was significantly greater (P=.004) than below the cemento-enamel junction. CONCLUSIONS: The framework design for metal ceramic restorations can affect the esthetics of the adjacent natural tooth. A minimum 2-mm facial cutback of the metal framework is necessary for there to be a significant difference in color change.

Current ceramic materials and systems with clinical recommendations: a systematic review.

STATEMENT OF PROBLEM: Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated. PURPOSE: This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use. MATERIAL AND METHODS: A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought. RESULTS: The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation. CONCLUSIONS: Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.

Accuracy of two impression techniques with angulated implants.

STATEMENT OF PROBLEM: Accurate recording of implant locations is required so that definitive restorations are properly supported and do not place additional stress on the implants. Angulated implants may result in inaccurate impressions, and the impression technique may affect the accuracy of the definitive cast. PURPOSE: The purpose of this study was to determine the effect the combined interaction of impression technique, implant angulation, and implant number has on the accuracy of implant definitive casts. MATERIAL AND METHODS: One definitive stone cast was fabricated for each of 6 experimental groups and 1 control group. All 7 definitive casts had 3 implants arranged in a triangular pattern creating a plane. In the 6 experimental groups, the center implant was perpendicular to the plane of the cast while the outer implants had 5, 10, or 15 degrees convergence towards or divergence away from the center implant. The control definitive cast had all 3 implants parallel to each another and perpendicular to the plane of the cast. Five open tray and 5 closed tray addition silicone impressions were made of each definitive cast. Impressions were poured with type IV dental stone, and a fine tip measuring stylus was used to record multiple axis (X-Y-Z) coordinates on the top surface of the implant hex and on the cast base. Computer software was used to align the data sets and vector calculations determined the difference in degrees between the implant angles in the definitive cast and the duplicate casts. Statistical analysis used repeated-measures ANOVA (alpha=.05) with post-hoc tests of significant interactions. RESULTS: The angle errors for the closed and open tray impression techniques did not differ significantly (P=.22). Implant angulations and implant numbers differed in average angle errors but not in any easily interpreted pattern (P<.001). The combined interaction of impression technique, implant angulation, and implant number had no effect on the accuracy of the duplicate casts compared to the definitive casts (P=.19). CONCLUSIONS: The average angle errors for the closed and open tray impression techniques did not differ significantly. There was no interpretable pattern of average angle errors in terms of implant angulation and implant number. The magnitude of distortion was similar for all combinations of impression technique, implant angulation, and implant number.

Compliance of resilient denture liners immersed in effervescent denture cleansers.

PURPOSE: Six resilient denture liners (RDL) were exposed to two immersion effervescent denture cleansers to evaluate change in compliance over a simulated 1 year time interval. MATERIALS AND METHODS: Ten samples of each material, Molloplast B, Mollosil, MPDS-SL, Permasoft, Softline, and Sofreliner were exposed to either Fixodent or Efferdent denture cleanser. A cyclic load was applied in a squarewave fashion to derive a load displacement curve to measure compliance at 0, 7, 30, 180, and 360 simulated days. RESULTS: All 12 of the material/cleanser combinations demonstrated a significant change in compliance at each time interval relative to baseline. Mollosil had the greatest increase in flexibility from baseline, and MPDS-SL had the smallest increase in flexibility. In general, chairside materials demonstrated greater change in compliance from baseline compared to laboratory materials. Materials subjected to Fixodent cleanser, when averaged over time, were significantly more flexible than materials exposed to Efferdent cleanser. CONCLUSIONS: Exposure of resilient soft liners to two common cleansers resulted in a significant increase in flexibility. This change in flexibility depended slightly, though significantly, on the type of cleanser, and appeared to be more significant with time. In general, chairside materials seemed to change more than laboratory-processed liners. The exception was Permasoft that was fabricated as a laboratory material but behaved like a chairside material. CLINICAL SIGNIFICANCE: The initiator of the polymerization reaction rather than the mode of polymerization may be more important in predicting a change in the flexibility of RDLs. Constituents within the oral environment may be more responsible for changes in RDL flexibility than denture cleansers.

Effect of finishing and polishing procedures on the gap width between a denture base resin and two long-term, resilient denture liners.

STATEMENT OF PROBLEM: The junction between a long-term, resilient denture liner and the denture base is difficult to finish and polish due to differences in the hardness of the materials. Gaps tend to form during finishing and polishing procedures. PURPOSE: This study measured the junctional gap between 2 long-term, resilient denture liners and a denture base material after different finishing and polishing procedures were performed. The surface smoothness of the 2 liner materials also was evaluated. MATERIAL AND METHODS: Molloplast-B and an experimental, heat-polymerized methyl siloxane-resin-based denture liner were processed (according to the manufacturer's instructions) against Lucitone 199 acrylic resin. Control specimens (n = 20) were 2 mm thick and flat. Experimental specimens (n = 64) were fabricated with a raised center section: a 3- x 5- x 15-mm half-cylindrical ridge with a junction at the top of the cylinder between the liner material and acrylic resin. The specimens were finished with 1 of 6 types of burs and polished with different combinations of rubber-impregnated acrylic polishers, pumice, and tin oxide. The finished specimens were examined and photographed with a scanning electron microscope, and the largest gap along the liner/denture base junction on each specimen was measured. Three-way analysis of variance without replication (P<.05) and post-hoc t tests were used to analyze the data and compare groups. RESULTS; Averaged across finishing and polishing techniques, a larger gap was recorded for the experimental liner material (22 microm) than for Molloplast-B (14 microm) (P<.00005). Qualitative evaluation suggested that the experimental liner material polished better than Molloplast-B. The smoothest surfaces were obtained when specimens were finished with fine-tooth cross-cut carbide burs and polished with both pumice and tin oxide. A comparison between polished and unpolished specimens, averaged over materials and finishing techniques, revealed that polishing reduced gap size (P=.015). CONCLUSION: Within the limitations of this study, the 2 denture liners tested behaved similarly. The results suggest that the size of the gap at the liner/denture base junction may be affected by finishing and polishing techniques and vary among materials.

Laser digitization of casts to determine the effect of tray selection and cast formation technique on accuracy.

UNLABELLED: STATEMENT OF PROBLEM; Several studies have attempted to determine the ideal combination of dental materials and laboratory techniques to produce the most accurate dental cast. Most have made use of 2-dimensional manual measuring devices, which neglect to account for the dimensional changes that exist along a 3-dimensional surface. PURPOSE: The purpose of this study was to determine the effect of impression tray selection and cast formation techniques on the dimensional change of a dental cast with the use of new, 3-dimensional optical digitizing technology. MATERIAL AND METHODS: Multiple impressions of a machined steel die that resembled a dental arch were made with custom and stock impression trays and vinyl polysiloxane impression material. The impressions were poured in type V artificial dental stone and allowed to set with the tray inverted or noninverted. The steel master die and stone casts were digitized with the Steinbichler Comet 100 Optical Digitizer, which was developed at the Minnesota Dental Research Center for Biomaterials and Biomechanics. Three-dimensional images of the stone casts were aligned to the 3-dimensional image of the master die and analyzed with AnSur-NT software. Multiple measurements of the master die and stone casts were analyzed to determine the accuracy of the 3-dimensional technology and of the impression and cast fabrication techniques. Planar distances between the center of each crown preparation were measured, as were crown heights. Data were analyzed with analysis of variance (P<.05), and root mean square error values were determined. RESULTS: Casts were compared with a total of 45 significance tests, of which only 4 yielded P<.05. There was no pattern to these results, which suggests that they were false-positive findings. CONCLUSION: Results obtained with the use of new optical digitizing technology indicated that neither impression tray type nor cast formation technique affected the accuracy of final casts.

Clinical evaluation of resilient denture liners. Part 2: Candida count and speciation.

PURPOSE: The purpose of this study was to count and to speciate Candida isolated from 2 resilient denture liners, Molloplast-B and MPDS-SL. MATERIALS AND METHODS: A group of 20 patients each had 1 maxillary denture and 2 mandibular dentures fabricated. One mandibular denture was lined with Molloplast-B, and 1 was lined with MPDS-SL. Each denture was used for 3 months. At the end of the 3-month period, the mandibular denture was surrendered, and a 5 x 5-mm circular resilient liner sample was obtained from the tissue surface of the lingual flange. Samples were processed, and Candida was isolated and counted. Speciation of Candida was performed using CHROMagar Candida and API 20C AUX strips. RESULTS: Molloplast-B had, on average, 5 times as many CFU/sample as MPDSL-SL, but this difference was not significant (p = 0.26). A sign test gave a similar nonsignificant trend (p = 0.057). CHROMagar identified several Candida species, and confirmation was made using API 20C AUX strips. One patient was lost to follow-up. Of 19 Molloplast-B samples, 7 had no growth, 4 grew C. albicans, 3 grew C. parapsilosis, 2 grew C. glabrata, 1 grew C. tropicalis, 2 grew a Trichosporon spp., and 2 grew a nonidentifiable colony. The analogous counts for 19 MPDS-SL samples were 10, 4, 1, 3, 0, 1, and 1 (p = 0.45 for culture positively, exact McNemar test). CONCLUSIONS: Candida growth on Molloplast-B was not significantly different from growth on MPDS-SL. Several yeast species were cultured from each material. The rates of culture-positive testing did not differ between the 2 resilient denture liners.

Clinical evaluation of a new resilient denture liner. Part 1: Compliance and color evaluation.

PURPOSE: A new experimental resilient denture liner (MPDS-SL; Lai Laboratories, Burnsville, MN) and Molloplast-B (Buffalo Dental Manufacturing, Syosset, NY) were clinically evaluated for compliance and color change over a 1-year period. MATERIALS AND METHODS: In this crossover study, each of 20 patients had 2 dentures fabricated with long-term, silicone-based resilient liners, 1 denture with Molloplast-B and the other with MPDS-SL. Each denture was used for 6 months, during which time each patient kept a journal detailing his or her use and cleaning regimen. The 2 materials were assessed for compliance and color at the beginning of the study and again after 3 months and 6 months of use. Compliance was determined by applying a 3-lb force to the surface of the material following a square-wave pattern, using a closed-loop servohydraulic testing system. The force and position values were recorded using a storage oscilloscope. Compliance was measured at 3 locations on each denture and analyzed using data-acquisition software. Images of the dentures were captured using a zoom stereomicroscope with a charge-coupled video camera and image analysis software. The color was measured at 3 locations on each denture; RGB and L* a* b* were calculated. RESULTS: Compliance increased from baseline to 3 months and from 3 months to 6 months for almost all locations on both materials. Molloplast-B and MPDS-SL differed in average change in compliance at 6 months; the average change in compliance from baseline to 6 months was 453 (standard error, 46) for Molloplast-B and 284 (standard error, 46) for MPDS-SL (p = 0.019). For both materials, color changed significantly from baseline to 3 months and from baseline to 6 months (p < 0.01). MPDS-SL changed significantly less than Molloplast-B from baseline to 6 months for R (p = 0.039), G (p = 0.037), B (p = 0.005), and L* (p = 0.042). CONCLUSION: For both materials, compliance increased over 6 months of wear. The color change for MPDS-SL was considerably less significant than that for Molloplast-B.