A 5-year prospective study on small diameter screw-shaped oral implants.

Alveloar ridges of limited dimensions could preclude the placement of dental implants of the regular dimension. Smaller diameter implants - narrow platform (NP) implants were commercially available to address this issue. The aim of the study was to determine the 5-year clinical performance of 3.3 mm diameter NP implants. Twenty-three machined screw-shaped NP implants were placed in nine patients (six males; three females) between 18 and 70 years of age. Clinical and radiographic examinations were performed annually for 5 years. Recognized implant success criteria was used. The criteria were based on the mean marginal alveolar bone loss, the placement of prosthesis of satisfactory appearance, and the absence of implant mobility, peri-implant radiolucency, pain, discomfort or infection. One implant failed at abutment connection. The remaining 22 implants were restored and functioned successfully according to the criteria. The mean marginal alveolar bone loss during the first year was 0.41 +/- 0.17 mm. The mean marginal alveolar bone loss between the second and fifth year was 0.03 +/- 0.06 mm. The success rate of NP implants according to a well-established set of criteria was 96%.

Development and evaluation of a questionnaire to evaluate clinical dental teachers (ECDT).

OBJECTIVES: To develop and test the psychometric properties (validity and reliability) of a questionnaire to evaluate clinical dental teachers. METHODS: An item (question) pool was generated with the use of a literature review, feedback from faculty staff, and from focus group discussions with dental students. Following factor analysis the validity and reliability of a revised questionnaire was assessed. This involved 148 dental students and 453 assessments of 29 clinical dental teachers. RESULTS: Effective clinical dental teaching (ECDT) scores were associated with 'global ratings' of the effectiveness of clinical dental teaching (P<0.01), indicating strong criterion validity. In comparison analysis there was strong agreement between students regarding ratings of individual clinical dental teachers, indicating good construct validity. Reliability was assessed by examining internal consistency of sub-scales and overall ECDT scale, and found to be good (Cronbach alpha's > 0.80). CONCLUSION: A valid and reliable measure to evaluate clinical dental teachers has been developed for use in a clinical academia setting, and has potential use as a quality assurance measure.

Changes in life quality following third molar surgery--the immediate postoperative period.

OBJECTIVES: This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. METHODS: One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK, were administered to the study group prior to surgery. Standardized surgical and analgesic protocols were followed. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days, completing both OHIP-14 and OHQoLUK daily. RESULTS: Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P<0.01) and this remained evident on POD2 (P<0.01), POD3 (P<0.01), POD4 (P<0.01) and POD5 (P<0.05). By POD6 and POD7 there was no significant difference in quality of life compared with preoperative status (P>0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. CONCLUSION: The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.

A study of the comparative efficacy of three common analgesics in the control of pain after third molar surgery under local anaesthesia.

BACKGROUND: The aim of this study was to evaluate the comparative efficacy of three commonly used analgesics (Panadeine, Diflunisal and Etodolac) in the control of pain after third molar surgery under local anaesthesia. METHODS: A randomized control study. Outcome of primary efficacy was judged by overall assessment of the area under the curve of graphs for pain intensity, measured from serial visual analogue scales over a 24-hour period. Other measures of efficacy included the number (per cent) of patients who took 'additional' analgesics and the incidence of adverse effects occurring in each treatment group over the study period. RESULTS: The three drugs were effective in the control of post-operative pain (p<0.01). Variations in pain intensity and the use of additional medication between the treatment groups were observed over the study period. The Diflunisal group experienced less pain than the Panadeine or Etodolac group (p<0.01). Furthermore, a lesser number of those in the Diflunisal group used additional medication compared to the other two groups (p<0.01). The incidence of side effects from all three drugs was low. CONCLUSION: Diflunisal is superior in the control of pain following third molar surgery under local anaesthesia than either Panadeine or Etodolac, and has few side effects.

Peri-implant bone loss: management of a patient.

This clinical report presents the prosthodontic management of early peri-implant bone loss in a partially edentulous patient. Two narrow Brånemark implants (3.3 mm in diameter) were placed to retain a mandibular implant prosthesis in the area of the mandibular left second premolar and first molar. Two weeks after the prosthesis was put into function, the distal implant exhibited soft tissue reactions. Radiographically, bone corresponding to 4 threads and 7 threads was lost at the mesial and distal sites, respectively. After occlusal load reduction was made to the existing prosthesis, bone was observed to have regenerated sufficiently to restore the defect radiographically, though not to the original level. The bone remained at a similar level at 36 months after treatment.

The edentulous mandible opposed by natural maxillary teeth: a report of six cases treated with implant-retained prostheses.

Dental restoration of the edentulous mandible opposing natural maxillary teeth is often associated with a number of problems, particularly in the occlusion, and an accelerated rate of alveolar bone resorption in the edentulous mandible resulting from occlusal loading. The advent of osseointegrated implants would seem to provide a new means of treating these cases. Accordingly, the cases of six patients for whom either fixed partial dentures or over-dentures supported by Brånemark implants were provided, are reviewed. Three of the mandibles were normal and three had bone grafts. Results so far indicate that this is a viable alternative for treating such cases.

Microbiology of the pericoronal pouch in mandibular third molar pericoronitis.

The microorganisms associated with mandibular third molar pericoronitis were investigated using direct microscopy and anaerobic culture method. The pericoronal pouch was sampled with paper points in A) 8 patients without mandibular third molar pericoronitis and B) 6 patients with mandibular third molar pericoronitis. Under the microscope, the microflora was found to be a complex mixture comprising gram-positive and gram-negative cocci, rods and filaments (including fusiform and curved rods), motile rods and spirochetes. Significantly higher proportions of motile, gram-negative rods were found in group B than in group A. The predominant cultivable microflora of 9 samples: A (4) and B (5) comprised several species of facultative and obligate anaerobic bacteria, namely Peptostreptococcus, Streptococcus, Actinomyces, Eubacterium, Propionibacterium, Veillonella, Porphyromonas, Prevotella, Bacteriodes, Fusobacterium, Campylobacter, Staphylococcus, Stomatococcus, Lactobacillus, Neisseria, Capnocytophaga, Haemophilus, Selenomonas and Centipeda species. The microflora in pericoronitis appeared similar to that of diseased periodontal pockets.

Pre-operative diflunisal for pain relief following third molar surgery under general anaesthesia.

In order to find out whether long-acting non-narcotic analgesics given pre-operatively reduce the post-operative pain and decrease the narcotic analgesic requirements following third molar surgery under general anaesthesia, thirty Hong Kong Chinese patients undergoing this procedure were randomly given either diflunisal or placebo one hour prior to anaesthesia. Pain reduction was monitored for ten hours from the end of surgery using visual analogue scales. Except in the first hour, pain reduction at each hour was significantly better in the diflunisal group than in the placebo group. Furthermore, only one patient required narcotic analgesics in the diflunisal group compared with five in the placebo group. In patients who had multiple tooth sectioning or very difficult surgery of one or both lower third molars, the requirement for post-operative analgesics was high in the placebo group.

Two-stage incisor transplant and orthodontic space redistribution.

This report describes a complex case with unerupted upper anterior teeth and other dental anomalies requiring the two-stage incisor transplantation technique in conjunction with two phases of orthodontic treatment. The case illustrates the benefits of careful planning and of limiting treatment goals to the needs and perceptions of the patient. The final result also emphasizes the aesthetic dental improvements now possible with a multidisciplinary approach.

The reliability of personal and family medical histories in the identification of hepatitis B carriers.

Blood specimens were obtained from 300 patients and were tested for the five hepatitis B virus (HBV) serum markers: HBsAg, HbeAg, anti-HBs, anti-HBe and anti-HBc. Medical histories were checked to determine any previous experience of HBV infection in the patients or their families. Serum markers showed that 54.3% of the group had evidence of earlier HBV infection, 10% were HBsAg carriers, and 3% were HBeAg-positive. The patients' own histories correctly identified carriers in 23.1% of those giving a positive HBV history (p less than 0.05). Family histories were found to be an unreliable means of detecting HBV carriers. HBeAg carriers were twice as likely to be identified by their histories than HBsAg carriers. Blood donation refusal was the most frequent indicator of previous HBV infection.

An investigation into the reduction of tooth contamination in delayed transplantation.

90 unerupted human teeth were removed surgically and were cultured for between 1 and 5 weeks in one of three storage media supplemented with different combination of antibiotics. Each tooth was screened for microbiological contamination after culture. Medium 199 with benzyl penicillin, cephaloridine and gentamicin gave the highest % of sterile teeth (82.1%). Discriminant analysis showed that the addition of antibiotics to the culture medium was the main factor contributing to sterility; irrigation with sterile saline during tooth removal, ultrasonic treatment before culture and the pre-operative tooth position were also found to be important.

The prevention of contamination of teeth stored for transplantation.

Tissue culture media and their application to the storage of teeth are described. The problems of contamination in culture and a method of achieving a sterility level of 73 percent are discussed. Contamination was reduced at each stage, using unerupted teeth, chlorhexidine disinfection, saline irrigation, ultrasonics, a laminar-flow cabinet, and four antibiotics in culture. A method of microbiologic screening is outlined.