Treatment Outcomes and Assessment of Oral Health Related Quality of Life in Treated Hypodontia Patients.

OBJECTIVES: 1. Assess treatment outcomes and oral health related quality of lifeM (OHRQoL) of hypodontia patients after completing dental treatment at the Eastman Dental Hospital and compare it with British public norms. 2. Assess factors which have an association with patients' reported OHRQoL. METHODS: Hypodontia patients who finished their treatment completed a 16-item questionnaire (UK oral health related quality-of-life measure), a list of four questions about their satisfaction with treatment received and a clinical assessment using modified USPHS criteria. RESULTS: The sample included 52 participants; median age 28 years (range 16 - 61 years). All participants had completed treatment for at least 6 months (range 6-60 months). Clinical assessment revealed 4 of the participants had complications requiring treatment. The OHRQoL mean scores of the sample were statistically significantly higher than the mean scores of the British public norms for most age groups (P⟨0.05). Factors which revealed association with OHRQoL scores were: gender (P=.047) and satisfaction with dental aesthetics (P=.006). CONCLUSIONS: Hypodontia patients following treatment reported higher OHRQoL average scores compared to the British population. Higher OHRQoL scores were related to patients' satisfaction with dental aesthetics after treatment. Females tended to report higher OHRQoL scores than males.

The role of orthodontics in the management of tooth wear.

Pathological tooth wear is a dental problem that affects all age groups and appears to be increasing in prevalence. A subset of these patients may benefit from a combination of orthodontic and restorative care which will be discussed in this article. Orthodontics can help to create the necessary vertical, anterior-posterior and mesio-distal space for restorative work, reducing the need for tooth reduction and lessening the biological costs of restorative care, helping to reposition the gingival margins where this impacts upon aesthetics, as well as correcting co-existing malocclusion.

The survival and clinical performance of anterior composite resin restorations and posterior indirect and cast restorations used to treat generalised tooth wear.

Objective To evaluate the survival and clinical performance of restorative materials used in the rehabilitation of generalised severe tooth wear within a UK NHS postgraduate teaching hospital.Methods The clinical performance of 527 restorations on 20 patients with generalised severe tooth wear was reviewed after a mean period of five years. Anterior teeth were restored with direct composite resin and posterior teeth with indirect restorations. The study used the modified United States Public Health Service criteria for restoration assessment. Survival of the restorations was analysed using Kaplan-Meier survival curves, the log-rank test and the Cox proportional hazards regression analysis.Results The sample included 20 participants: 13 men and 7 women, with a median age of 51.8 years (range: 33-73 years). The median survival time for all restorations was 11.3 years when major failures were considered and 5.9 years for restorations when all types of failure were considered. A median survival time of 5.9 years for composite resin restorations and over seven years for cast restorations was found when considering all failures. Composite resin restorations commonly failed as a result of fracture, wear and marginal discolouration. Factors significantly influencing restoration survival were the material used, aetiology, incisal relationship and tooth location. The biological complications associated with this treatment regime were rare. Patient satisfaction remained generally high, with greatest dissatisfaction related to treatment time.Conclusions The use of anterior composite resin with posterior indirect restorations to treat generalised severe tooth wear is a viable treatment modality with very few major complications.

The influence of patients' decisions on treatment planning in restorative dentistry.

UNLABELLED: As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out. CLINICAL RELEVANCE: Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

Multidisciplinary management of missing maxillary central incisors in children and adolescents.

Missing maxillary central incisors can impact a patient's psychological wellbeing and smile aesthetics. Comprehensive management of such cases requires a multidisciplinary team approach, often involving orthodontic, paediatric and restorative dental teams. This paper summarises the various management options for these complex patients.

The use of implants at an increased vertical dimension of occlusion to correct a scissor bite: a case report.

Traditional methods of achieving anchorage for orthodontic treatment are dependant on the presence of a sufficient number of teeth with adequate root support. With the success and predictability of osseo-integration, dental implants are being used frequently to obtain absolute anchorage. This case report illustrates the successful use of implants with a combined orthodontic-restorative approach to obtain anchorage in a partially dentate patient to correct a transverse cross-bite (scissor bite) relationship. The implants were subsequently restored to replace missing posterior teeth. The importance of a multi-disciplinary approach to planning and close liaison between the orthodontist, surgeon and restorative dentist during the treatment phase are discussed.