Placement and replacement rates of amalgam and composite restorations on posterior teeth in a military population.

OBJECTIVE: Replacement rates of direct dental restorations have been reported to be 37% to 70%, occupying a large proportion of a general dentist's time. Variations in the rate of initial placement and replacement of direct dental restorations may be associated with material placed (amalgam or composite), age, caries risk of the patient, and other factors. The purpose of this research was to clarify where the majority of patient care time is spent as a restorative Army dentist regarding either the initial placement or replacement of failed restorations; and how the location, caries risk, and material used (amalgam or composite) affects replacement rates. METHODS: This retrospective cross-sectional study gathered data from 600 randomly selected military patient dental records. All paper records were reviewed and cross checked with the digital record and digital x-ray databases. Record review was limited to all direct dental restorations placed in the posterior dentition within the past 2 years (March 2011 to March 2013). Statistical analysis was accomplished using chi-square tests and logistic regression analyses. RESULTS: Of the 600 charts reviewed, 525 were male, 75 were female, with an average age of 26 years (SD=6), ranging from 17 to 54 years. A third of the patients were classified as high, moderate, and low caries risk, respectively. The total number of posterior direct dental restorations placed was 2,117. Initial restorations totaled 1,429 (67.5%), and replacement restorations placed totaled 688 (32.5%). Four hundred forty-one of the 688 direct dental restorations replaced were amalgam (64%), the 247 remaining direct restorations replaced were composite (36%). Mandibular first molar dental restorations were replaced the most often (23.1%) while mandibular first premolar restorations were replaced the least often (0.9%). Older patients were more likely to have replacement of an existing restoration. CONCLUSIONS: Military dentists spend about one-third (32.5%) of their time replacing existing direct dental restorations. The majority of direct dental restorations placed and replaced were amalgam. No significant difference was found between composite and amalgam restorations. Location was shown to be significant with first molars and second molar restorations failing with the highest frequency. There was no significant difference found between male and female patients. As patient's age increased, the number of replacement restorations also increased.

A nodular-ulcerative form of secondary syphilis in AIDS.

An uncommon variant in the pre-AIDS era, lues maligna is a nodular-ulcerative form of secondary syphilis. We present a case of a 41-year-old man with HIV infection who developed fever, chills, nausea, vomiting, right upper quadrant abdominal pain, weight loss, watery diarrhea, and a painless, nonpruritic rash. He had diffuse nodular-ulcerative lesions in various stages of development. He was found to have a CD4 count of 101 cells/mm3 (22%), an HIV viral load of 2,735,060 copies/mL, and a positive rapid plasma reagin at 1:64. He was started on emtricitabine, tenofovir, and dolutegravir, as well as doxycycline. He was given benzathine penicillin 2.4 million units intramuscularly and within hours developed a Jarisch-Herxheimer reaction. Skin lesions showed signs of healing, and constitutional symptoms improved 48 hours later.

Longer length Baha™ abutments decrease wound complications and revision surgery.

OBJECTIVES/HYPOTHESIS: To study the complication rates of skin overgrowth, infection, and the need for revision surgery in longer length Baha™ abutments. STUDY DESIGN: Prospective observational cohort study compared with a retrospective historical control. METHODS: After the University of Nebraska Medical Center (UNMC) Institutional Review Board approval was obtained, data was collected from a prospective 8.5-mm abutment study group of 21 subjects with informed consent from October 2011 through October 2012, and was compared to a retrospective 5.5-mm abutment historical cohort of 23 patients who had undergone Baha™ by the same surgeon from May 2010 to October 2011. Patient demographics, body mass index (BMI), smoking status, and wound complications (skin overgrowth, infection, the need for revision surgery) were statistically investigated and compared between the groups. RESULTS: Forty-four patients were studied. The groups were similar in smoking status, diabetes, and a female preponderance. The 8.5-mm abutment group was older (P = 0.012). The average BMI for both groups was classified as overweight and nearly obese (BMI 28.8). Rates of infection, skin overgrowth, and the need for revision surgery related to wound complications were significantly decreased in the longer 8.5-mm abutment group (P = 0.020, P = 0.012, P = 0.007, respectively). BMI did not correlate with decreased infection, skin overgrowth, and the need for revision surgery based on abutment length as hypothesized (P = 0.214, P = 0.206, P = 0.408). CONCLUSIONS: The 8.5-mm abutment lends to decreased complications postoperatively, including infection, skin overgrowth, and the need for revision surgery. LEVEL OF EVIDENCE: 3b.