Prosthetic Management of Severe Mandibular Deviation in a Hemi-Mandibulectomy Patient Following Osteoradionecrosis.

Rehabilitation of a patient after hemi-mandibulectomy without reconstruction represents a prosthodontic challenge. Indeed, mandibular deviation and decreased occlusal contacts are a common presentation post-surgery. This paper reports on a patient who presented with these challenges and where chronic osteoradionecrosis has resulted in significant mandibular deviation. A maxillary cobalt chrome mandibular deviation device, designed with palatal bite plane and constructed using 3D printing methods, resulted in a successful outcome. The authors aim to show how restorative management of similar patients can be successful using a modern approach.

A survey of dental practitioners in Wales to evaluate the management of deep carious lesions with vital pulp therapy in permanent teeth.

Objective To evaluate the management of deep carious lesions with vital pulp therapy in permanent teeth by dental practitioners within Wales.Design Postal questionnaire.Setting General practitioners (GDS), community (CDS) and hospital-based dentists (HDS) in Wales.Methods Community and hospital dental services with a remit for provision of restorative dentistry (CDS = 71; HDS = 46) and general dental practitioners (N = 510) were approached regarding their management of deep carious lesions with vital pulp therapy in permanent teeth. The postal questionnaire took the form of an anonymous survey. Questions covered usage parameters, training issues and reasons for material choice.Results The response rate was 29%. The majority of HDS (89%) used MTA or Biodentine for vital pulp therapy in contrast to GDS (41%) and CDS (32%). The main reasons cited for avoiding the use of MTA or Biodentine included cost, lack of training and difficulty in material handling.Conclusion Usage of MTA or Biodentine for vital pulp therapies is low in the general dental and community dental settings. Cost and lack of training are the main barriers for the uptake of these materials. Postgraduate training may be useful in addressing these barriers. Increasing their adoption would be advantageous as they have been shown to produce a more predictable outcome compared to traditional materials (for example, calcium hydroxide).

An audit of the quality of base metal cast restorations provided within the restorative department of a UK dental institute.

BACKGROUND: Gold alloy has long been used in dentistry for the fabrication of cast restorations due to its material and clinical properties and known excellent longevity over long-term follow-up. The cost of gold has increased dramatically in recent years (by 450% in the past ten years). The use of base metal alloys as an alternative would lead to a considerable cost saving: a cobalt chromium alloy is around 98% cheaper than gold alloy at the time of writing. NHS regulations state which alloys are permissible for use in cast restorations in dentistry, and certain 'non-precious gold' alloys should not be used. MATERIALS AND METHODS: A prospective audit was carried out in our unit into the standard of cast restorations in cobalt-chromium alloy. The standard set before the audit was established by a prior audit of gold alloy restorations with measures of clinical and technical factors. RESULTS: Base-metal alloy restorations were considerably cheaper; but were of a poorer clinical standard than gold-alloy and required more frequent adjustment and remake (17% compared to 5%).