Are clinical skills no longer a prerequisite to being a competent dental surgeon?

The clinical standards of dentists are never re-assessed and the dental regulator, unlike the General Medical Council, has not introduced revalidation; therefore, the clinical standards of a dentist are rarely, if ever, re-evaluated.

The Effect of Mini Dental Implant Number on Mandibular Overdenture Retention and Attachment Wear.

Purpose: Evaluate the effect of different mini-implant numbers on overdenture retention and evaluate attachment wear following one year of simulated placement/removal. Material and Methods. Nine models simulating atrophic mandibles held 27 mini dental implants in three groups of 2, 3, and 4 mini-implants. A total of 1080 simulated placement/removal cycles were carried out, and a digital force gauge was used to measure the overdenture dislodgment force. The means of the retention forces were analyzed using SPSS with one-way ANOVA and post hoc (p < 0.05). The inner diameter of attachment inserts was evaluated using a light microscope before and after testing. A paired t-test was used to compare the mean of inner ring diameters (p < 0.05). Results: The retention was significantly reduced regardless of the mini dental implant number, but the number affected overdenture retention. The placement of 4 mini dental implants provided higher retention and less reduction in retentiveness. However, no significant difference was found when 3 mini dental implants were compared to 2 mini dental implants (p = 0.21). Microscopic examination showed abrasion wear in all inserts following testing. However, the inserts of the 4 mini dental implants showed less wear than those used for 2 or 3 mini dental implants with p ≤ 0.001 and p ≤ 0.001, respectively. Conclusion: Mini dental implant overdenture retention force and attachment wear could improve by increasing the mini dental implants to 4. However, there was no difference in retention force or attachment wear when 2 or 3 mini dental implant overdentures were compared.

Does the Length of Mini Dental Implants Affect Their Resistance to Failure by Overloading?

Objective: We aimed to evaluate the failure resistance of different lengths of mini dental implants from the same manufacturer, and to assess their failure following overloading. Materials and Methods: According to the ISO 14801, 15 mini dental implants 2.4 mm in diameter, with lengths of 8.5 mm, 10 mm, or 13 mm, were subjected to compression loading until failure using a universal testing machine. The mean load-to-failure values for each length of the mini dental implants were calculated and analysed using SPSS®, via one-way ANOVA (p < 0.05). Results: The mean load to failure for mini dental implants was 329 N (SD 6.23), 326 N (SD 5.95), and 325 N (SD 6.99) for the 13 mm, 10 mm, and 8.5 mm implants, respectively. A comparison of means showed no significant difference between the groups (p = 0.70). The tested mini dental implants exhibited bending failure modes below the first thread. Conclusion: Under high compressive loading testing, there was no effect of the length on the failure of the mini dental implants following overloading. Moreover, all tested mini dental implants with different lengths showed the same failure mode and distortion location.

The Effect of Number and Distribution of Mini Dental Implants on Overdenture Stability: An In Vitro Study.

The rotational movement of mini dental implants (MDIs) overdenture disturbs the function of the prosthesis. Many dentists place more MDIs to improve the overdenture stability; however, the influence of the MDIs number and distribution on the overdenture resistance to para-axial dislodgment has not been investigated. Seven resin models simulating atrophic mandibles housed twenty MDIs placed according to seven arrangements. Acrylic overdentures were fabricated for each cast and were dislodged five times in lateral, anterior and posterior directions, and the peak load dislodgment was measured. Each overdenture underwent 540 axial removal/placement cycles. The para-axial dislodgments were measured again, and data were compared. Dislodgment force values were measured in all directions, and the data were analysed using analysis of variance ANOVA and post hoc (p < 0.05). After six months of simulated placement/removal, increasing the MDI number showed a difference in resistance to para-axial dislodgment. The distribution affected the resistance to dislodgment in some directions. The inter-implant distance of 27 mm provided better resistance to posterior dislodgment than placing two MDIs close together at 19 mm. The placement of three MDIs at any distribution showed no significant difference except for resistance to posterior dislodgment. FourMDIs placed at any distribution showed a significant difference in all groups in all tested directions. The resistance to the para-axial dislodgment of MDI overdenture could improve with the increasing MDIs number and careful planning of MDI distribution.

Analysis of Residual Ridge Morphology in a Group of Edentulous Patients Seeking NHS Dental Implant Provision-A Retrospective Observational Lateral Cephalometric Study.

A convenience sample of 154 edentulous patients referred for implant provision at a Regional National Health Service Dental Hospital in the North West of England were identified. The cephalometric radiographs that were taken as part of the patient baseline investigation were assessed. Digital tracing was used to measure the anterior maxillary and mandibular bone height and ridge angle with respect to the maxillary and mandibular planes. The mean height of the bone in the maxilla was found to be 14 mm, and the mean ridge angle for the anterior maxillary residual ridge is 104°. The mean height of bone in the mandible was 18 mm, while the mean ridge angle for the anterior mandibular residual ridge was 77°. Using the Cawood and Howell classification demonstrated that class VI mandibles were the most common. The cross-sectional shape of the mandible varied, with the triangular shape most common. Although there was adequate bone stock for implant placement in these cases, the mandibular residual ridge resorption presents a lingual inclination to the residual bone. The limited residual ridge position and inclination would dictate that conventional implant placement could be challenging.

Head and Neck Cancer Patients ­ Information for the General Dental Practitioner.

Salivary gland damage is the most common adverse effect associated with radiation therapy to the head and neck. A combination of hyposalivation and dietary changes, with a reduced emphasis on oral hygiene practices can contribute to a massive increase in a person's caries risk status. This can be further complicated by limited mouth opening. To enable optimal dental care for head and neck cancer patients before, during and after radiation therapy, patients must be informed and educated about the potential risks of dental caries and the preventive strategies available. All patients should receive a pre-radiotherapy dental assessment by a Restorative Dentistry Consultant. This information will be delivered to the patient, often at an emotionally charged time, and can be lost amongst all the information related to other aspects of his/her cancer management. General Dental Practitioners (GDPs) are therefore in a pivotal position to reiterate this information post radiation therapy and ensure compliance with preventive strategies, with the overall aim to improve quality of life and avoid the need for future extractions and the resulting risk of osteoradionecrosis. Clinical relevance: This article highlights the GDP's role in the shared management of head and neck cancer patients who have received radiotherapy as part of their cancer treatment. The critical issue of dental caries, one of the late effects of radiation-induced hyposalivation, will be focused upon. Other side-effects, such as trismus and osteoradionecrosis, will also be discussed. This article aims to supply GDPs with accurate information to provide to their patients with post radiation therapy, whilst highlighting what treatment is within their remit and when it may be appropriate to refer.

A pilot randomised controlled trial evaluating mini and conventional implant retained dentures on the function and quality of life of patients with an edentulous mandible.

BACKGROUND: Total tooth loss (edentulism) can be a debilitating condition, impacting on ability to chew, speak and interact with others. The most common treatment is with complete removable dentures, which may be successful, but in the lower jaw, bone resorption that worsens over time makes denture-wearing difficult. Two dental implants in the mandible to retain the lower denture has been advocated as the gold standard of treatment, but has not been universally provided due largely to financial constraints and also patient fear. Mini implants (MI) are cheaper and less invasive than conventional implants (CI), but may not have equivalent longevity. Therefore, it is unknown whether they represent a cost-effective treatment modality over time. The aim of this pilot randomised controlled trial was to assess the feasibility of carrying out a trial on this cohort of patients, and to inform the study design of a large multicentre trial. METHODS: Forty-six patients were randomly allocated to receive either two mini implants or two conventional implants in the mandible to retain their lower dentures. Quality of life (QoL) questionnaires, pain and anxiety scores, and an objective "gummy jelly" chewing test were carried out at multiple timepoints, along with detailed health economics information. Implants were placed one-stage, and an early loading protocol was utilised. Patients were reviewed 8 weeks post-placement, and finally at 6 months. Implant failure, recruitment and retention rates were recorded and analysed. RESULTS: The pilot study demonstrated that it is possible to recruit, randomise and retain edentulous (mainly elderly) patients for an implant trial. We recruited to target and retention rates were acceptable. The large number of questionnaires was onerous for participants to complete, but the distribution of scores and feedback from participants helped inform the choice of primary and secondary outcomes in a full trial. The chewing test was time-consuming and inconsistent. Implant failure rate was low (1/46). The data on indirect costs gathered at every visit was viewed as repetitive and unnecessary, as there was little or no change between visits. CONCLUSIONS: The pilot study has shown that acceptable recruitment and retention rates are achievable in this population of patients for this intervention. The results provide valuable information for selection of outcome variables and sample size calculations for future trials. TRIAL REGISTRATION: (ISRCTN): 87342238 Trial registration date: 05/07/2013.

The Learning of Difficult Visual Discriminations by the Moderately and Severely Retarded.

A procedure to effectively and efficiently train moderately and severely retarded individuals to make fine visual discriminations is described. Results suggest that expectancies for such individuals are in need of examination. Implications for sheltered workshops, work activity centers and classrooms are discussed.

Sagittal condylar angle and gender differences.

PURPOSE: The purpose of this study was to measure sagittal condylar inclination (SCI) in male and female participants and to assess differences between the two groups. This measurement has a clinical value in setting the articulator SCI before fabrication of indirect restorations. MATERIALS AND METHODS: The study included 32 dental students, 16 men and 16 women (aged 18 to 40 years). The participants had no signs of muscular or articular pain. SCI was recorded for participants using a CADIAX® compact 2 electronic axiograph. RESULTS: The mean SCI in both men and women varied between 26.1° and 61.8°, with a mean of 41.9° (SD 7.8). The mean right SCI was 42.0° (SD 8.5), and the mean left SCI was 41.9° (SD 9.2). The mean SCI for men was 40.3° (SD 7.9), and the mean for women was 43.6° (SD 7.7). No statistically significant difference in SCI values was found between the right and left side (p = 0.995), or between the male and female groups (p = 0.133). Also, no correlation could be found between SCI and the age of the participants (r(2) = 0.016, p = 0.489). CONCLUSIONS: The mean value of SCI was within the range reported in previous studies. SCI is highly variable, but this variability does not seem to be attributed to condylar asymmetry, gender, or age of the adult participants. This high variability suggests that independent condylar measurements should be conducted for each patient instead of relying on reported average values.

Dental dilemmas: Endodontics or dental implants?

UNLABELLED: This narrative review explores treatment planning options in restorative dentistry. The growth of dental implants, as an accessible and predictable treatment option, gives practitioners a useful tool for managing the missing tooth or teeth with a hopeless prognosis. Traditionally, endodontics and fixed prosthodontics have been used to restore teeth and spaces where the outlook for such treatment appears reasonable. Practitioners may, however, question the predictability and cost effectiveness of such an approach where, at times, it might appear that replacement of a compromised tooth with a dental implant could be a more predictable option. The evidence base for these treatment options is explored and discussed, and suggestions are made for future management strategies. CLINICAL RELEVANCE: A clear knowledge and understanding of the scientific literature for implants and endodontic treatment is necessary if practitioners are to make an evidence-based approach when treatment planning these modalities for their patients. This is particularly true in cases where there may appear to be a reasonable choice between the two of these.

Peri-implant diseases.

UNLABELLED: Peri-implant diseases are inflammatory conditions that affect the soft and hard supporting tissues around implant fixtures. Peri-implant mucositis usually responds to oral hygiene instructions, scaling and prophylaxis, but peri-implantitis, which involves bone resorption, has less predictable treatment outcomes following non-surgical management. Adjunctive treatment for decontaminating sites may include the use of antimicrobials and resistant cases may sometimes be managed with a surgical approach. CLINICAL RELEVANCE: As dental implant-retained prostheses become more popular the prevalence of peri-implant complications will also increase. Dental practitioners and care professionals should appreciate their potential roles in the management of these conditions.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: 6-month fatigue retention values.

This in vitro study evaluated the 6-month fatigue retention provided by 5 paired overdenture attachments placed at 3 different interimplant distances (19, 23, and 29 mm). Mean fatigue retention was calculated for each attachment type and compared with the retention produced by the other attachments tested and the initial retention values published earlier. Interimplant distance was found to play a significant role only in the retention of the Hader bar with red and yellow clips. A significant reduction in retention values was observed for 4 of 5 attachment types.

Micromechanical versus chemical bonding between CoCr alloys and methacrylate resins.

INTRODUCTION: As adhesive systems for bonding to metals have developed in dentistry, considerable importance is attached to the preparation of the metal alloy for both mechanical and chemical bonding. Different grit sizes when sandblasting Cobalt Chromium (CoCr) will provide a different three-dimensional surface for bonding. Previous reports have shown that 4-Methacryloyloxyethyl trimellitic anhydride (4-Meta) resins offer high bond strengths to CoCr alloy, with various surface preparations providing varying bond strengths. The relevance of this to bond strength was assessed. OBJECTIVES: The aim of the study was to evaluate the importance of grit size of alumina in the preparation of CoCr alloy and to determine the effect on the tensile bond strength of four different acrylic resins to the CoCr alloy. METHODS: Ten specimens were prepared within each group of four resins. Four grit sizes were assessed, 50, 110, 250 microm, and a range from 180 to 330 microm. The specimens were tested both within one day of production after storing at 37 degrees C in phosphate-buffered saline for seven days and after thermocycling. RESULTS: Grit size resulted in a change in average contact surface area available for bonding. A significant difference (p < 0.01) existed in bond strengths between each of the materials, but no significant difference (p = 0.0673) was determined when different grit sizes were included. SIGNIFICANCE: It was concluded that grit size determined the available contact surface area of CoCr alloy for bonding but did not determine the bond strength that could be achieved between acrylic resins and CoCr alloy as a result of the poor adaptation of the resin to the complex surface topography.

The influence of interimplant distance and attachment type on the retention characteristics of mandibular overdentures on 2 implants: initial retention values.

PURPOSE: This in vitro study aimed to investigate the influence of (1) the interimplant distance and (2) the type of attachment on the retention of mandibular overdentures on 2 implants. MATERIALS AND METHODS: Three stone casts were fabricated, each with 2 implant analogues embedded at distances of 19, 23, and 29 mm apart. Three different interchangeable mandibular overdenture attachments were secured onto the analogues: Hader bars, ball abutments, and stainless steel keepers for new generation neodymium-iron-boron magnets. In total, 45 groups of paired attachments were tested for initial vertical peak tensile load at the 3 interimplant distances. RESULTS: Interimplant (interclip) distance played a significant role only in the retention produced by the Hader bar/red clip configuration. At 19 and 23 mm, the ball/socket attachments were statistically more retentive than the yellow clips, white clips, and magnets, but not compared to the red clips. At 29 mm, the ball abutments showed statistical superiority compared with all other attachments. Mean clinical intercanine distance for conventional full dentures was 22.88 mm. CONCLUSION: Interimplant distance can affect the initial retention of mandibular overdentures on 2 implants depending on the type of attachment used. For a predetermined interimplant distance, attachment performance varies greatly.

Peer assessment of professional competence.

BACKGROUND: Current assessment formats for medical students reliably test core knowledge and basic skills. Methods for assessing other important domains of competence, such as interpersonal skills, humanism and teamwork skills, are less well developed. This study describes the development, implementation and results of peer assessment as a measure of professional competence of medical students to be used for formative purposes. METHODS: Year 2 medical students assessed the professional competence of their peers using an online assessment instrument. Fifteen randomly selected classmates were assigned to assess each student. The responses were analysed to determine the reliability and validity of the scores and to explore relationships between peer assessments and other assessment measures. RESULTS: Factor analyses suggest a 2-dimensional conceptualisation of professional competence: 1 factor represents Work Habits, such as preparedness and initiative, and the other factor represents Interpersonal Habits, including respect and trustworthiness. The Work Habits factor had moderate, yet statistically significant correlations ranging from 0.21 to 0.53 with all other performance measures that were part of a comprehensive assessment of professional competence. Approximately 6 peer raters were needed to achieve a generalisability coefficient of 0.70. CONCLUSIONS: Our findings suggest that it is possible to introduce peer assessment for formative purposes in an undergraduate medical school programme that provides multiple opportunities to interact with and observe peers.