Factors associated with dental erosions in gastroesophageal reflux disease: a cross-sectional study in patients with heartburn.

BACKGROUND AND AIM: Dental erosion (DE) represents a frequent condition in adults and the elderly. The gastroesophageal reflux disease (GERD) is considered an important endogenous factor causing dental erosions. The objective of this study was to assess the prevalence of DE in GERD patients and to establish the correlation between pathogenic intrinsic and extrinsic factors of DE and their relation to GERD. METHODS: A cross-sectional study was conducted on 263 patients (median age 43). Patients with heartburn were recruited in two countries with different prevalence of GERD. Patients were recruited from France (n=158, 60%) and Romania (n=105, 40%) including 163 females and 100 males. The Basic Erosive Wear Examination (BEWE) index for diagnosis and evaluation of dental erosion was used. Based on the value of BEWE score, each patient was included in a risk group for DE development (low risk: BEWE=3-8, medium risk: BEWE=9-13, high risk: BEWE ≥14). Patients filled a questionnaire regarding GERD symptoms, medications, life style. Salivary parameters (pH and buffering capacity) were also assessed and analyzed. RESULTS: DE was significantly more frequent and more severe in GERD subjects than in the non-GERD controls. Low salivary pH but not salivary buffering capacity was associated with BEWE scores. Buffering capacity however was significantly more altered in patients with BEWE score over 9 (medium DE) than in patients with mild DE (BEWE <9). Although extrinsic factors (consumption of citrus fruits, soda drinks) were associated with DE in GERD, there was no statistical correlation with the BEWE score. From the total of 263 patients, 229 (87.1%) presented BEWE score <9, and 34 (12.9%) presented BEWE ≥9. The DE was significantly associated with the presence of GERD (p<0.001). BEWE score >9 was more frequently present in GERD patients (30 patients: 21.3%) than in non GERD patients (4 patients: 3.3%). DE were more frequent in French subjects compared to Romanian subjects. Romanians had lower BEWE scores than the French. CONCLUSIONS: DE is more frequent and more severe with GERD vs. non-GERD. DE in GERD is associated with extrinsic dietary factors like citrus fruits and soda drinks.

Complete denture fabrication with CAD/CAM technology: a case report.

Demographers agree that the so-called elderly population will increase steadily in the future. Not only will their numbers increase, but they will live to an older age. In the case of fully edentulous patients, implant treatment is a possibility, but for many, rehabilitation by means of full removable dentures is still the preferred option. In recent decades, computer-aided design/computer-aided manufacturing (CAD/CAM) has brought about what can only be described as a revolution in dental offices and dental laboratories. CAD/CAM has many areas of application, and these are constantly increasing. In response to the growing demand from users, CAD/CAM can now produce sets of complete removable dentures using a virtual design and fabrication process. A protocol for a new CAD/CAM-supported method is presented here in a clinical case report. Laboratory procedures are simplified because a number of the conventional steps have now disappeared. Today, it is possible to design the shape of the teeth for each patient, which results in a better customization of the dentures. Combined with appropriate staining of the teeth and denture base, this method produces full removable dentures that integrate very well into the patient's face to ensure a good esthetic result.

Laypersons' esthetic perception of various computer-generated diastemas: a pilot study.

STATEMENT OF PROBLEM: Managing excess anterior spacing is a common problem in dental practice. During orthodontic or restorative treatment planning, clinicians must decide how to distribute this space. However, few reports are available in the dental literature about the attractiveness and esthetic impact of anterior spaces other than midline diastemas. PURPOSE: The purpose of this study was to compare the esthetic perception of 4 different anterior diastemas, including simian diastemas (symmetrical diastemas between lateral incisor and canine), diastemas suggested by Frush and Fisher (asymmetrical diastemas between lateral incisor and canine and between central and lateral incisor), and by Lombardi (slight midline diastema and 2 larger diastemas between central and lateral incisors), and a midline diastema. MATERIAL AND METHODS: A picture of a young woman's smiling face was modified by using photoediting software to create the 4 previously mentioned diastemas. The resulting pictures were presented to laypersons questioned in French public places. The participants were asked to rank the pictures from most to least attractive, then to rate them with a mark from 1 to 10. RESULTS: One hundred and five participants completed the questionnaire. The median ranks and scores attributed to the pictures from most to least attractive were as follows: simian diastemas, 1 and 8; Frush and Fisher diastemas, 2 and 7; Lombardi diastemas, 3 and 5; and midline diastemas, 4 and 4, respectively. The hierarchy (simian diastemas>Frush and Fisher diastemas>Lombardi diastemas>midline diastemas) could be established statistically for the scores (P=.03, P<.001, and P<.001, respectively) but not for the ranks when adjusting on subjects' sex and age (P=.11, P=.03, and P=.06, respectively). CONCLUSIONS: The results showed an esthetic hierarchy of anterior diastemas. The negative perception of anterior diastemas seems to mainly be related to the presence and width of a midline diastema. These results can guide clinical decisions for patients with excess anterior spacing.

Patients' perspective on dental aesthetics in a South-Eastern European community.

OBJECTIVES: To assess the importance attributed to dental aesthetics by subjects from a Romanian community. In addition, the role played by dental color, the group-distributions based on the self-evaluation of dental color and the previous experience regarding whitening treatments are analysed. METHODS: A multiple-choice questionnaire was administered to 540 patients in dental offices in Cluj-Napoca, Romania; the subjects were also asked to self-evaluate their dental shade, using a set of images as a comparison. Answers to the questionnaires were statistically analysed using Microsoft Excel and SPSS 13.00 (Pearson's chi-square test, Fisher's exact test, Kendall's tau b). RESULTS: From the participants, 17.96% were motivated by aesthetic reasons to ask for treatment; most of the patients evaluated their smile as "acceptable" (38.51%) or "having some defects" (29.44%) and were self-included in groups of medium and dark shades (33.7% and 33.89%, respectively). Whilst 22.40% of the subjects considered the dental color as being the most evident defect of their dentition, 39.07% indicated a self-perception of "an abnormal dental shade". A strong correlation between darker self-assessed tooth color-groups and the self-perception of an abnormal tooth color was found (Chi square p≪0.001, Kendall's tau-c=0.44, with p≪0.001). Previous whitening treatments were reported by 8.88% of the subjects. CONCLUSIONS: Among patients who wanted to improve one of their oral functions, the majority requested changes in aesthetics. Dental shade is one of the aspects recognized as problematic by the participants, but nonetheless the percentage of patients who had previously benefited by whitening treatments was moderate.

A comparison between a new visual method of colour matching by intraoral camera and conventional visual and spectrometric methods.

OBJECTIVES: The objective of this study was to evaluate the new colour-matching Sopro Shade concept of the Sopro 717(®) intraoral camera (assisted visual evaluation method) by comparing it with the Vita 3DMaster(®) shade guide under the True Shade(®) lamp and the Vita Easyshade(®) spectrophotometric method. METHODS: The basic colour of the maxillary right central incisor and canine of 38 participants was determined by three examiners then repeated the next day using the three evaluation methods. Two examiners were experienced clinicians and one was a Sopro intraoral camera engineer. The Vita 3D-Master shade guide was used with all three colour-matching methods. Kendall's tau-b correlation coefficients between the different series of tooth-colour evaluations were computed and two-tailed t-tests for paired samples were applied. RESULTS: Regardless of the tooth examined, significant intra-examiner agreement (p < 0.05) occurred between the visual and the assisted visual methods. Inter-examiner reliability was higher for canines than for central incisors, for all three methods. When comparing the two visual assessments with the spectrophotometric one, Kendall's tau-b correlation coefficients were lower. When comparing the two visual methods, significant agreement (p < 0.05) was found for both canines and central incisors. CONCLUSIONS: Within the limitations of this study, the Sopro Shade concept of the Sopro 717 intraoral camera is a reliable assistance to visual colour assessment compared with conventional visual methods. The reproducibility and reliability of all methods and examiners' measurements for canines were generally higher than those for central incisors. The possible clinical impact of the lower level of agreement between the two visual methods (conventional and assisted) compared with spectrophotometry should be studied further.

A 4-year follow-up of two complete mandibular implant-supported removable prostheses in a patient with severe rheumatoid polyarthritis: case report.

Rheumatoid polyarthritis is a systemic autoimmune disease characterized by chronic synovitis and bone damage associated with significant functional disability and morbidity. This case report describes a 4-year follow-up of a 56-year-old female receiving polymedication for severe rheumatoid polyarthritis and osteoporosis with a fully edentulous maxilla treated with two osseointegrated implants supporting a removable mandibular prosthesis. No practitioner wanted to use implants to stabilize her mandibular prosthesis because of the health risks involved. This report encourages the dental practitioner to be familiar with the symptoms and oral manifestations of rheumatoid polyarthritis in order to help manage this disease when patients lose all of their teeth.

Ultrasonic sulcus penetration: a new approach for full crown preparations.

Newly developed ultrasonic diamond-coated tips (UDT) have been created for sulcus penetration and intracrevicular finish line preparation and polishing. One hundred forty-two freshly extracted premolars and molars were employed for a cutting efficiency test. Dentin surface roughness was analyzed with an optical profilometer and a scanning electron microscope. Within a reasonable cutting time, the UDTs possessed sufficient dentin-cutting capacity. The surface roughness of dentin prepared with the UDT can be improved by using a smaller grit size UDT or a smooth tip set at lower power, and the roughness approaches that of dentin prepared with a referenced red diamond bur. A clinical protocol of ultrasonic sulcus penetration with these developed UDTs is proposed.