In vitro comparison of instrumental and visual tooth shade determination under different illuminants.

STATEMENT OF PROBLEM: While a considerable body of literature deals with the comparison between visual and instrumental tooth color determination, in most of these studies either the number of color specimens or the number of examiners is too small to allow for a general statement about such a subjective method as visual color determination. Furthermore, perceptual aspects like perceptible or acceptable color differences are often not considered. PURPOSE: The purpose of this study was to investigate the precision of a spectrophotometer in tooth shade determination compared with visual color matching using a shade guide in vitro. Moreover, the influence of different illuminants as well as of sex and professional experience of the examiners on visual color matching was analyzed. MATERIAL AND METHODS: Fifty examiners (13 men, 37 women; without dyschromatopsia), grouped by professional experience, determined the shades of 10 prosthetic teeth with the Vitapan classical shade guide under 4 illuminants (daylight, halogen, fluorescent [5000 K], fluorescent [nonspecific ceiling light]) and with a spectrophotometer (Shadepilot). Reproducibility (precision) of color determination was characterized by the average of the highest percentages of interexaminer agreement for each specimen. Additionally, color differences (ΔE) were calculated based on CIELab values. RESULTS: The mean reproducibility of the spectrophotometer was 92.2%, while for visual examination it was 43.7%. The corresponding differences in CIELab color space amounted to ΔEinstr=2.6 and ΔEvis=5.2. Illuminants and professional experience showed a significant influence, while sex did not. CONCLUSION: While the spectrophotometer provided higher reproducibility, considering the color differences, the results obtained by visual inspection were still satisfactory. The differences due to type of illuminant, degree of experience, and sex of the examiners are of little practical relevance.

Long term clinical outcome of dental implants placed in a patient with Singleton-Merten syndrome.

PATIENTS: Singleton-Merten syndrome is an extremely rare autosomal dominant condition with less than 10 reported cases in the literature. It is characterized by abnormal aortic calcifications and dental abnormalities. The goal of this case report is to discuss the abnormal oral clinical features and the modified treatment protocol that was used in order to achieve osseointegration of dental implants in a patient having abnormal bone density and bone turnover associated with Singleton-Merten Syndrome. DISCUSSION: Following extraction of the remaining teeth, titanium implants (Friadent GmbH, Mannheim, Germany and Straumann(®), Basel, Switzerland) were placed in the upper and lower jaw of the patient. The upper jaw which was treated with dental implants, received a bar supported implant retained prosthesis and the lower jaw an implant retained telescopic prosthesis. The patient was regularly followed up for the past 13 years during which, clinical and radiological evaluation of osseointegration was undertaken. All the loaded implants showed clinical and radiographic evidence of osseointegration. With a follow up of 13 years after insertion of the first implant, the patient reported functioning well with no complications. CONCLUSION: The treatment with dental implants in the extremely rare Singleton-Merten syndrome patients is a reasonable treatment option to rehabilitate maxillofacial aesthetics and establish normal function of the jaws.

Evaluation of the effectiveness of a semi-finished occlusal appliance--a randomized, controlled clinical trial.

INTRODUCTION: Painful temporomandibular disorders (TMDs) are usually treated with physiotherapy, self-exercises, medication-based therapy and splint therapy. For splint therapy different types of splints are available. Therefore this randomized controlled study compared the effectiveness of a semi-finished occlusal appliance (SB) with a laboratory-made occlusal appliance (SS) in myofascial pain patients. METHOD: The trial subjects allocated to the experimental groups with the (SB) occlusal appliance and those provided with a laboratory-made occlusal appliance (SS) did, in addition, receive conservative treatment (self-exercises, drug-based and manual therapy). The control group was given conservative therapy (CO) only. Overall, a total of 63 patients participated in the study with each group consisting of 21 subjects. RESULTS: When the first follow-up examination took place (14 days after splint insertion) mouth opening within the SB group was significantly enlarged. When the second examination was conducted (2.5 months after splint insertion) mouth opening was significantly enlarged in both splint groups when compared with the initial value. In the control group, no significant enlargement of mouth opening was detected. At no point there was a significant reduction in the number of pressure-sensitive areas of the TMJ. On palpation of the masticatory muscles however, a significant reduction in the number of pressure-sensitive areas could be observed within the CO group and the SS group after 2.5 months. When comparing pain reduction (muscle/joint pain) and mouth opening, no significant differences could be detected between the treatments. CONCLUSION: The results suggest that TMD should be treated conservatively. In cases of restricted mouth opening, the additional use of occlusal appliances can eliminate the patient's discomfort more quickly. In this context, the tested, semi-finished occlusal appliance appears to offer an immediately available, temporary alternative to laboratory-made splints.

Implant dentistry at the focus of liability lawsuits.

PURPOSE: In recent years, the growing readiness on the part of dental patients to take legal action has resulted in an increasing number of medical liability lawsuits. The aim of this retrospective analysis was to highlight aspects of these lawsuits of special significance, to subject them to both qualitative and quantitative analysis, and to show how conflicts can be avoided. MATERIALS AND METHODS: Forty relevant court decisions from the year 1984 onwards were found in online databases and through direct inquiries at the courts. These were supplemented by 21 reports prepared by experts at the University of Muenster, Department of Dental Medicine, commissioned by courts in connection with ongoing lawsuits. Analysis was initially based on formal aspects of the cases and reports. It was later supplemented by differentiated assignment of the questions addressed by the courts to the expert consultants. The principles underlying the judgments as to the liability arising from the terms of the contract were also assigned to the expert consultants in a differentiated manner. RESULTS: The results revealed marked differences in the frequency of liability-prone aspects of treatment. While the majority of judgments referred to the obligation to take due care during the preparatory and treatment phases, infringement of the obligations to provide information and to keep records played more than a minor role. Moreover, 90% of all cases represented combined charges covering various aspects, including those related to consequential failings. DISCUSSION AND CONCLUSION: The detailed qualitative analysis of the grounds quoted and of the lines of reasoning can therefore be summed up in clearly defined recommendations aimed at helping the clinician avoid conflicts by observing the judicial requirements.