Effect of different advancement positions on the maximum retrusive force of the mandible.

INTRODUCTION: Functional appliances lead, in different degrees, to loss of anchorage in the lower arch. By anchoring them to the mandibular bone, any dental side effects may be avoided and the skeletal effect enhanced. Stability of bone-borne fixation would be affected by forces created by the pull of the masticatory muscles. We aimed to identify mean maximum forces produced by mandibular retrusive muscles, at different degrees of advancement. SUBJECTS AND METHODS: Eighteen healthy adult volunteers participated in the study. Maximum retrusive force was measured using a splint/load cell system. Readings of the maximum forces of retrusion were taken from five mandibular positions: unstrained retruded position, and 4, 5, 6, and 7 mm anterior to the unstrained position. Data were presented as means ± SD and anova was performed to examine statistical significant differences between means of the maximum retrusion force. RESULTS: Mean maximum retrusion force ranged between 63.3 and 198.2 newtons at the unstrained and 7 mm positions, respectively. It increased as the distance of advancement increased, being statistically significantly (p < 0.05) less at unstrained position compared with all advancement distances, 4 mm of advancement than 6 and 7 mm advancement, 5 mm of advancement than at 7 mm advancement. CONCLUSION: Magnitude of the forces exerted by muscles during voluntary maximum retrusion movement from different advancement positions increased proportionately as the retrusion distance increased up to 7 mm. Such range of high forces might be important to consider when designing a bone-borne functional appliance.

Self-perceived preparedness for dental practice amongst graduates of The University of Hong Kong's integrated PBL dental curriculum.

OBJECTIVES: To determine how prepared for dental practice graduates from the integrated problem-based learning (PBL) dental undergraduate curriculum at The University of Hong Kong (HKU) perceive themselves to be and to identify factors associated with self-perceived preparedness. MATERIALS AND METHODS: A postal questionnaire was sent to five cohorts of dentists who had graduated from HKU's integrated PBL curriculum between 2004 and 2008. Using a 4-point Likert scale, the questionnaire assessed the self-perceived level of preparedness in 59 competencies grouped in nine domains. Responses were dichotomised into 'poorly prepared' and 'well prepared'. RESULTS: The response rate was 66% (159/241). The mean proportion (±standard deviation) of respondents indicating well-preparedness was 72.0±15.1% overall, and for each domain was as follows: general patient management, 93.1±12.1%; practice management, 81.0±22.2%; periodontology and dental public health, 73.5±19.3%; conservative dentistry, 92.5±13.1%; oral rehabilitation, 62.8±24.0%; orthodontics, 23.0±32.9%; managing children and special-needs patients, 64.8±28.9%; oral and maxillofacial surgery, 52.2±25.2%; and drug and emergency management, 84.7±22.6%. The odds of self-perceived well-preparedness were increased for cohorts graduating in 2004 and 2005 and graduates working in a non-solo dental practice. CONCLUSIONS: Dental graduates of HKU's integrated PBL curriculum felt well prepared for the most fundamental aspects of dental practice. However, apparent deficiencies of training in orthodontics and oral and maxillofacial surgery will need to be addressed by continuing education, postgraduate training and planning for the new 6-year undergraduate curriculum in 2012.

ART and conventional root restorations in elders after 12 months.

Successful use of atraumatic restorative treatment (ART) in children has been reported, but little information is available regarding its use in older adults. The hypothesis of this study was that survival rates of root restorations placed by both ART and the conventional technique were similar. Root-surface caries lesions in 103 institutionalized elders in Hong Kong were treated randomly by either: (1) the conventional approach-caries removed by dental burs, and the cavity filled with light-cured resin-modified glass ionomer; or (2) the ART approach-caries removed by hand instruments, and the cavity filled with chemically cured high-strength glass ionomer. In total, 84 conventional and 78 ART restorations were placed. After 12 months, 63 conventional and 59 ART restorations were reviewed, and the respective 12-month survival rates were 91.7% and 87.0% (p > 0.05). It is concluded that the survival rates of both types of root restorations were high and similar.

A testing machine for dental air-turbine handpiece characteristics: free-running speed, stall torque, bearing resistance.

The measurement of performance characteristics of dental air turbine handpieces is of interest with respect to product comparisons, standards specifications and monitoring of bearing longevity in clinical service. Previously, however, bulky and expensive laboratory equipment was required. A portable test machine is described for determining three key characteristics of dental air-turbine handpieces: free-running speed, stall torque and bearing resistance. It relies on a special circuit design for performing a hardware integration of a force signal with respect to rotational position, independent of the rate at which the turbine is allowed to turn during both stall torque and bearing resistance measurements. Free-running speed without the introduction of any imbalance can be readily monitored. From the essential linear relationship between torque and speed, dynamic torque and, hence, power, can then be calculated. In order for these measurements to be performed routinely with the necessary precision of location on the test stage, a detailed procedure for ensuring proper gripping of the handpiece is described. The machine may be used to verify performance claims, standard compliance checks should this be established as appropriate, monitor deterioration with time and usage in the clinical environment and for laboratory investigation of design development.

Discharge of lubricant from air turbine handpieces.

OBJECTIVE: To demonstrate and quantify the discharge of lubricating oil from high-speed air turbine handpieces whilst running. MATERIALS AND METHODS: Dye-marked oil (Kavospray, KaVo) was used to lubricate four handpieces (Quiet-Air, Midwest) and the air discharged from around the lower bearing was directed at the moving chart paper on a recorder whilst running for 40 minutes. Secondly, seven new handpieces (Quiet-Air, 300SE, Midwest; Topair 796, Topair 795, W+H; VIP-Sigma, Pana-air, NSK; Lares, Lares Research) were cleaned, weighed and then lubricated with unmarked oil (Kavospray, KaVo). Oil discharge was determined gravimetrically over runs of 240 minutes. Data were fitted to the logistic dose response function. RESULT: The dye-marked oil tests showed that oil was discharged for at least 40 minutes in the direction of the bur. The gravimetric tests showed that oil continued to be discharged up to at least 240 minutes, and that the usual practice of removing excess lubricant by running for 1-2 minutes was ineffective in preventing cut-surface contamination. SIGNIFICANCE: Bonding procedures in dentistry may be jeopardised by oil contamination from handpiece lubricants. Decontamination with a detergent is suggested as a means of ensuring effective adhesive dentistry.

Characterization of six textile dyes as fluorescent stains for flow cytometry.

Few fluorescent stains specific for cell constituents other than DNA are available. To assess their potential use as fluorescent stains for flow cytometry, the cell staining specificity of 55 compounds, originally synthesized for use as textile dyes and fluorescent brighteners, was explored and their excitation and emission wavebands determined. From these, six dyes were chosen for more detailed analysis. All six are vital stains, with excitation wavelengths allowing their use with an argon ion laser, and specific for a range of cell structures including mitochondria, Golgi bodies, lipid droplets, nuclear membrane, and endoplasmic reticulum. Concentrations as low as 0.01-0.25 microM were found to be adequate for most purposes, and high background fluorescence was not a problem. Their specificity allows differentiation between non-cycling and cycling cells. The properties of two of the stains allows their combination with propidium iodide or ethidium bromide for simultaneous determination of DNA content profiles. Being vital stains, usable at very low concentrations, and specific for a range of cell organelles, these six stains may be of considerable utility in flow cytofluorometry. We suggest that other textile dyes may be of use in flow cytofluorometry, or that their structures may form a starting point for the synthesis of further fluorescent stains of enhanced specificity.

Flow cytofluorometric evidence for the differential radioresponsiveness of aneuploid and diploid cervix tumours.

We are presently involved in a prospective study of the relationship between DNA content profiles, and their changes during treatment, determined by flow cytofluorometry, and patient prognosis and response to therapy for cancer of the uterine cervix. To date, 348 patients have been included in the study over a 54-month period. Data on these patients have shown that DNA aneuploid tumours are significantly more radioresponsive than diploid cervix tumours. Analysis of the data on 213 patients with a minimum follow-up time of 15 months has, however, failed to show an overall more favourable prognosis conferred by tumour DNA aneuploidy. Analysis of the relationship between clinical stage and disease state and tumour DNA ploidy, however, suggests that aneuploid tumours metastasize to distant sites at an earlier stage of the disease than diploid tumours and local recurrence rates for diploid tumours, in late stage disease, are double those for aneuploid tumours. Improved staining procedures, and instrument modification, has also shown that cervix tumour heterogeneity is of considerably greater frequency than at first appeared to be the case (approximately 75% of DNA aneuploid tumours show heterogeneity.

Quantitation by flow cytofluorometry of response of tumours of the uterine cervix to radiotherapy.

We are presently involved in a project to investigate the use of flow cytofluorometry in assessing, by means of serial biopsies, the response to radiotherapy of tumours of the uterine cervix. This technique enables changes in the DNA content profiles and content of proliferating cells in the tumour biopsies to be determined at intervals as therapy progresses. A means has been devised to quantitate the content of hyperdiploid cells, hypertetraploid cells, and dead and dying cells, by computer analysis of DNA vs. RNA scattergrams obtained by flow cytofluorometric analysis. Plotting of these parameters for the serial biopsies vs. time since start of tumour irradiation presents a graphical indication of the response of the tumour to irradiation. Over 100 patients (stage Ib and IIa) have been followed during intracavitary (Cathetron) therapy with parallel flow cytofluorometric analysis and histopathological assessment of serial biopsies. Patterns are beginning to emerge from these analyses which promise to indicate within 14-21 days and sometimes earlier the extent of radioresponsiveness of the tumour. These patterns may also be of assistance in planning modified dose fractionation schedules to obtain improved therapeutic ratios.

Flow and free running speed characterization of dental air turbine handpieces.

OBJECTIVES: Dental air turbine handpieces have been widely used in clinical dentistry for over 30 years, yet little work has been reported on their performance. A few studies have been concerned with measurement of speed (i.e. rotation rate), torque and power performance of these devices, but neither investigations of functional relationships between controlling variables nor theory dealing specifically with this class of turbine have been reported. This has hindered the development of satisfactory methods of handpiece specification and of testing dental rotary cutting tools. It was the intention of the present work to remedy that deficiency. METHODS: Measurements of pressure, temperature, gas flow rate and rotation rate were made with improved accuracy and precision for 14 ball bearing turbine handpieces on several gases. Functional relationships between gas properties, supply pressure, flow rate, turbine design factors and free running speed were identified and equations describing these aspects of behaviour of this class of turbine developed. RESULTS: The rotor radius, through peripheral Mach number, was found to be a major determinant of speed performance. In addition, gas flow was found to be an important limiting factor through the effect of choke. CONCLUSIONS: Each dental handpiece can be treated as a simple orifice of a characteristic cross-sectional area. Free running speed can be explained in terms of gas properties and pressure, with allowance for a design-specific performance coefficient.

Torque, power and efficiency characterization of dental air turbine handpieces.

OBJECTIVES: In a previous paper the flow and free running speed characteristics of dental air turbine handpieces were discussed. The present work was to continue the analysis and characterization of these handpieces by addressing the issues of torque, power generation, efficiency and the specification of figures of merit to aid comparative testing and selection. METHODS: Using the principle of the rope brake, torque was determined from stall to free running at a variety of supply pressures for fourteen models of handpiece. Using previous results for air flow rate and free running speed, power and efficiency were calculated. RESULTS: Stall torque was demonstrated to depend on rotor position. Dynamic torque was found to closely approach the expected linear relationship over the range from stall to free running. Several figures of merit (performance indices) were identified which might be used for routine rating and specification of handpieces. CONCLUSIONS: Standardized testing can now be performed and effective figures of merit derived to characterize the behaviour of dental air turbine handpieces.

A laboratory evaluation of two brands of disposable air turbine handpiece.

OBJECTIVE: To report on the essential performance characteristics of two brands of disposable air turbine handpiece and on aspects of their safety and convenience for clinical use. MATERIALS AND METHODS: Oralsafe and Feathertouch disposable handpieces were characterised using a variety of techniques in respect of the following: turbine rotor radius, equivalent orifice radius, stall torque coefficient, pressure effectiveness, power index, efficiency index, sound level and instrument retention force. RESULTS: Free-running speed versus pressure curves for many of the disposable handpieces showed marked deviations from the expected smooth form. Considerable variation between examples of each type was found in most measured values. Evidence of eccentric rotors and high bearing friction was not found. CONCLUSIONS: Both brands of disposable handpiece had a number of problems: poor performance, vibration, excessive noise, variability of behaviour, poor bearings. Use of these devices is difficult to recommend. Improvement in design seems necessary.

The development of the dental high-speed air turbine handpiece. Part 1.

The high-speed air turbine handpiece is currently used for most dental cutting procedures and has been in widespread use for more than thirty years. Although reports of its historical background have been previously published these have not dealt with all relevant developments and some inconsistencies exist. The history of the development of turbines and their application in dental cutting systems from the late 19th century to the present day is now reviewed. An historical account of the recognition of benefits that may accrue from rotary cutting at increased speeds is given and the various attempts that have been made to design equipment capable of high speeds are discussed. Consideration is given to the development of non-rotary cutting devices, as is the failure of these adequately to replace the air turbine handpiece for routine work. It is concluded that the air turbine handpiece will continue to hold a leading position in the field for some years to come but that future improvements would be facilitated by the development of an understanding of the theoretical aspects of its behaviour.

Aspects of the design of modern dental air turbine handpieces.

Air turbine handpieces are manufactured with a wide range of alternative design features which may influence their suitability for particular clinical procedures. In this article a general account of these features is presented and their advantages and disadvantages are discussed. Some deficiencies in current methods of stating equipment specifications are reported and suggested improvements are given. Where appropriate, general recommendations are made regarding handpiece selection for clinical practice.

The present status of dental rotary cutting performance tests.

Appropriate methods of assessing the cutting ability of handpiece and rotary cutting instrument combinations are needed for research into the processes involved in dental cutting. They are also required for the development of improved devices and recommendations on operation as well as for equipment specification and standards testing. In reviewing the literature on dental rotary cutting performance testing to evaluate available methods, the factors which may influence clinical cutting behaviour are identified as those related to characteristics of the operator, handpiece, rotary cutting instrument, coolant/lubricant used and workpiece material. Existing industrial cutting theory is of limited help in understanding dental cutting in view of the differences between the control of relevant variables in the two cases. Consideration is given to the ways in which the important variables have (or have not) been controlled in past studies of dental cutting and thus the clinical relevance of available methods evaluated. Serious problems such as the lack of suitable test workpiece materials, as well as deficiencies in current knowledge of operator behaviour, handpiece characteristics and effects of coolant/lubricant application are noted. It is concluded that before improved, clinically relevant tests can be developed, further fundamental research in these areas is essential and that until this is done, further work under arbitrary experimental conditions would be of little value.

Dental air turbine handpiece performance testing.

Air turbine handpieces are expected to continue to be widely used as the main means of carrying out dental cutting work and scope exists for further design improvements. An understanding of the theoretical principles governing the performance of these devices seems essential for the systematic development of better handpiece designs and methods of specification. Furthermore, for experimental work on cutting behaviour with air turbine equipment, this knowledge is required for appropriate characterization of the performance of the particular handpiece used with respect to actual rates of energy disposition. The literature relating to air turbine handpiece performance is critically reviewed to assess currently available methods of measuring important variables such as speed, torque, and power. In this, consideration is given to the current state of knowledge of the influence on these variables of air pressure, flow and turbine design features. It is apparent that, although various measurement methods have been described and data for individual handpieces published, no attempt has yet been made to explore the functional relationships that exist between the variables. It is concluded that there is a need to identify the factors influencing turbine performance, to develop measurement systems which would provide adequate accuracy and precision and then to investigate the functional relationships between these relevant variables.

Failure analysis of the ball bearings of dental air turbine handpieces.

BACKGROUND: The aim of this study was to identify the nature and causes of deterioration and failure in dental handpiece ball bearings and thus provide guidance for clinical handling for service longevity. METHODS: The bearings of 36 turbine assemblies were dismantled for visual inspection, documented using a digital camera, and examined using scanning electron microscopy, as appropriate. RESULTS: For the metal parts of the ball bearing assembly, defects observed were mainly wear arising from the running load and corrosion. This was in the form of scratches and discoloured circumferential bands on the balls, and dull or worn surfaces extending around the circumference of the raceways. Cage damage including cracking, fracture, surface rubbing and distortion occurred, in varying degrees, in every failed turbine. CONCLUSIONS: Dental ball bearing failure modes have been identified. Cumulative effects of damage from corrosion and mechanical factors lead to handpiece deterioration. The cage was found to be very vulnerable to damage, and this may be the key limitation on bearing lifetime. Autoclaving may contribute to that, as it does to corrosion in the absence of adequate lubrication, but this seems to be minor in comparison to the effects of abuse. There is no justification for failing to observe usage and sterilization instructions.

A randomized trial on root caries prevention in elders.

Root caries is common in institutionalized elders, and effective prevention methods are needed. This clinical trial compared the effectiveness of four methods in preventing new root caries. From 21 residential homes, 306 generally healthy elders having at least 5 teeth with exposed sound root surfaces were randomly allocated into one of four groups: (1) individualized oral hygiene instruction (OHI); (2) OHI and applications of 1% chlorhexidine varnish every 3 months; (3) OHI and applications of 5% sodium fluoride varnish every 3 months; and (4) OHI and annual applications of 38% silver diamine fluoride (SDF) solution. Two-thirds (203/306) of the elders were followed for 3 years. Mean numbers of new root caries surfaces in the four groups were 2.5, 1.1, 0.9, and 0.7, respectively (ANOVA, p < 0.001). SDF solution, sodium fluoride varnish, and chlorhexidine varnish were more effective in preventing new root caries than giving OHI alone.