A survey of participation in managed care programs by endodontic specialists.

A survey was published in the Quarterly Survey of Dental Practice (QSDP) Special Topics that dealt with contractual agreements in dentistry. This survey evaluated general dental practitioner participation apart from that of dental specialists in general. The Quarterly Survey of Dental Practice survey was modified and used in the present study to specifically determine the participation by endodontists in various contractual insurance agreements, including Preferred Provider Organization and Health Maintenance Organization programs. A 10% sample of practicing endodontists was randomly selected to participate in this survey. Questionnaires (331) were sent out, and 229 or 69% were returned. Total participation by endodontists responding to this survey in any Health Maintenance Organization and/or Preferred Provider Organization insurance plans was 31.3%; however the total percentage of patients treated under these insurance plans was only 6.6%. These results were similar to those in the 1994 survey in which it was shown that 27% of the general dental practitioners and 41% of the dental specialists participated in one or more of these insurance programs and treated respectively, 5% and 9%, of their patients under these plans. Although participation in various managed care programs by endodontists in this survey was close to one-third, the total number of patients treated under these plans was low. Overall patients treated under fee-for-service arrangements by endodontists responding to this survey formed 85.3% of their patient pool. It does not appear from the results of this survey that managed care insurance has a significant impact on the practice of endodontics. It can be postulated that endodontists are unwilling to accept more than a small reduction in fees to join managed care plans, and they also desire to retain full control of their dental practice.

Endodontic patient recall procedures: a national survey of endodontic practices.

A survey was conducted to measure the extent of patient recall procedures and perceived success and failure in treatment from a sample of endodontists. A comparison to the accepted Quality Assurance Guidelines set forth by the American Association of Endodontists was conducted. Three hundred surveys were mailed to as many active members of the American Association of Endodontics. Two hundred thirty-three responses were returned for a response rate of 77.6%. The only statistically significant finding was that military practitioners in general do not have an active recall system. This was significant at the p < 0.008 level.

Apical sealing efficacy of two reverse filling techniques versus cold-burnished Gutta-percha.

The apical seal produced by the cold-burnished gutta-percha method and two amalgam reverse filling techniques was investigated in an in vitro study using 36 extracted human single-rooted teeth. Following root canal obturation, 27 teeth were divided into three experimental groups and each group was subjected to one of the three following filling techniques: (a) cold-burnishing of gutta-percha; (b) amalgam reverse filling; and (c) amalgam reverse filling in conjunction with cavity varnish. The remaining nine teeth served as controls (4). The teeth were placed in methylene blue dye for a period of 1 wk, after which they were retrieved, washed, sectioned, and the apical dye penetration measured. The results showed that amalgam with cavity varnish demonstrated less dye penetration than the other experimental groups. The difference was statistically significant (p less than 0.0001).

Long-term sealing efficacy of four root surface sealing materials used in endodontic leakage studies.

Fifty extracted human maxillary anterior teeth were biomechanically instrumented and divided into five equal groups, four experimental and a control. The teeth in the experimental groups had their root surface coated with one of four sealants; epoxy, casting resin, sticky wax, or nail polish. The roots of the remaining teeth were not coated and served as controls. All of the teeth were mounted in the caps of scintillation vials. Five microliters of [3H]uridine were deposited in the root canal space and disintegration counts were obtained over time periods of 1, 4, 8, 12, and 36 wk. At the conclusion of the experiment, sticky wax was demonstrated to provide a superior seal (p < 0.0001).

An in vivo evaluation of an electronic apex locator that uses the ratio method in vital and necrotic canals.

The purpose of this study was to compare the canal length determined by an apex locator to the apical constriction in both vital and necrotic canals. Informed consent was obtained from patients waiting to have teeth extracted. The teeth were anesthetized, isolated, and accessed. The pulp was considered vital if bleeding was present in the pulp chamber. The Root ZX was used to measure the root canal length. The file was cemented into place, and the tooth was extracted. Twenty-nine teeth containing 34 cemented files were studied, and the distance from the apical constriction was measured. The Root ZX was 82.3% accurate to within 0.5 mm of the apical constriction. The mean distance from the apical constriction was 0.21 mm in vital cases versus 0.49 mm for necrotic cases. There was no statistical difference between the ability of the Root ZX to determine the apical constriction in vital canals versus necrotic canals.

Comparison of effect of intracanal use of ketorolac tromethamine and dexamethasone with oral ibuprofen on post treatment endodontic pain.

The purpose of this study was to compare the pain-reducing efficacy of dexamethasone and ketorolac tromethamine when used as an intracanal medication, with oral ibuprofen and a placebo. An additional objective was to establish if any relationship exists between the incidence and severity of pretreatment pain and the incidence and severity of postinstrumentation pain. A total of 48 patients who presented to the University of Illinois postgraduate endodontic clinic were invited to participate. Patients were randomly assigned to 1 of 4 groups: oral ibuprofen, placebo, dexamethasone, or ketorolac tromethamine. Patients were asked to evaluate their pretreatment pain when they presented to the clinic with a Visual Analog Scale. The root canal treatment was performed in two appointments. The first appointment consisted of cleansing and shaping of the canal/s and placement of an intracanal medication. All teeth were closed with a sterile cotton pellet and IRM. Each patient was sent home with a Visual Analog Scale to fill out at 6, 12, 24 and 48 h after initiation of therapy. At the 12-h period, both dexamethasone and ketorolac provided statistically significant better pain relief than placebo. At the 24-h period, only ketorolac demonstrated better pain relief than the placebo. There were no statistically significant differences among the groups at 6 and 48 h. Although ibuprofen pain ratings were less than the placebo at all time points, the reduction was not significant. In addition, no significant differences were demonstrated between ibuprofen and either dexamethasone or ketorolac.

National survey of endodontists and selected patient samples: infectious diseases and attitudes toward infection control.

A survey was conducted of 591 patients from endodontic practices located in six large municipalities in the United States. A comparison was made between the self-reported incidence of transmissible diseases from patients medical histories to national statistics for the incidence of hepatitis B, herpes, tuberculosis, and HIV/AIDS. A national survey of 422 endodontists was also conducted. This survey was used to determine the beliefs and attitudes of practicing endodontists toward infection control techniques and infectious diseases. Compared with previous surveys, a trend toward increasing use of the hepatitis B vaccine, gloves, and greater acceptance of medically compromised patients was found.

Diagnosis and treatment of class II division 2 malocclusion.

Class II, Division 2 malocclusions often have skeletal patterns more nearly approaching Class I than Class II, Division I. Incisor relationships are unique. Treatment problems related to this malocclusion require that the clinician pay particular attention to the vertical dimension. Also, the prevalence of mandibular movement pattern irregularities, coupled with the "droopy incisor" phenomenon so characteristic of this malocclusion, requires careful individual case analysis. The use of simplified initial appliance mechanics to rectify some of these problems is discussed.

Occlusal contacts following orthodontic treatment: a follow-up study.

Occlusal contacts in maximum intercuspation were examined in a sample of 40 patients at the end of active orthodontic treatment and again an average of 21 months later. An increase in the total number of contacts was due to more actual and near contacts on all posterior teeth and more near contacts on anterior teeth. When the results were compared to a previous short term study, continued settling of the occlusion occurred beyond an initial three months of retention. Few contacts changed their location between the occlusal inclined planes and central grooves, suggesting minimal settling of the occlusion in a buccolingual direction.

Long-term stability of dental relationships after orthodontic treatment.

Adult changes in selected occlusal parameters are measured, with the study sample limited to 72 subjects with a history of malocclusion treated orthodontically 12 to 35 years previously. Variations were large. Most of the corrections were retained, with mean changes tending toward pretreatment values.

Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander.

Rapid maxillary expansion (RME) in the adult is thought to be an unreliable procedure with several adverse side effects and, consequently, surgically assisted RME is considered the preferred procedure. The purpose of this paper is to study the efficacy of nonsurgical RME, and to determine the incidence of complications such as relapse of the expansion, pain and tissue swelling, tipping of the molars, opening rotation of the mandible and gingival recession. Rapid maxillary expansion using a Haas expander was examined in 47 adults and 47 children. A control group of 52 adult orthodontic patients who did not require RME was also studied. Students' t-test, and the analysis of variance followed by the Scheffe test were used to determine if there were significant differences among time periods and among the 3 study groups. The mean transarch width increase was similar in adults and children who had RME; 4.6 +/- 2.8 compared to 5.7 +/- 2.4 mm for the molars and 5.5 +/- 2.4 compared to 5.7 +/- 2.5 mm for the second premolars. In the adults, transarch expansion and the correction of the posterior crossbites were stable following discontinuance of retainers (mean 5.9 years). If the expander was properly fabricated, and turned no more than once a day, the procedure was well-tolerated. Rapid maxillary expansion in adults flared the molars buccally only 3 degrees per side. The mandibular plane and lower facial height were unchanged. The adults achieved 18% of their transmolar expansion at the height of the palate and the remainder with buccal displacement of the alveolus. The children achieved 56% of their expansion by an increase at the height of the palate with the remainder due to displacement of the alveolus. There was some buccal attachment loss (0.6 +/- 0.5 mm) seen in the female subjects associated with RME, but the extent was clinically acceptable. This resulted in significantly longer clinical crowns, but rarely caused exposure of buccal root cementum. Complications were infrequently observed or of minimal consequence. The results indicate that nonsurgical RME in adults is a clinically successful and safe method for correcting transverse maxillary arch deficiency.

Comparison of preferences in lip position using computer animated imaging.

The objectives of this study were to examine the esthetic preferences of lip position in males and females, and to compare them with each other and with a common orthodontic standard using a custom computer animation program. The sample consisted of 53 young adult subjects, 25 males and 28 females. The sample was divided into orthodontically treated and untreated subjects. ANOVA and Scheffé tests were carried out to determine differences between the responses of the various groups. Also, t-tests were used to compare subjects' responses to a commonly used orthodontic standard (Ricketts' E-line). The results indicated a sex-effect, with females preferring fuller lips than males. Significant differences were also found between orthodontically treated subjects and untreated subjects, with untreated subjects preferring fuller lips. Differences were significant at p<0.05. Furthermore, both males and females preferred lip fullness greater than the Ricketts' values.

Methodologies for evaluating long-term stability of dental relationships after orthodontic treatment.

A comprehensive review of literature which considers methodologies for studying long-term occlusal stability is presented. This article focuses on the evaluation of plaster study models because occlusal changes are best reflected in longitudinal casts. Of particular interest is the assessment of crowding in the dentition and the various physical and mathematical procedures used to evaluate the measurement of space available. Indices used to assess the overall occlusal results of treatment are also presented.

Computer based methodology for construction of orthodontic arch wire templates.

This paper presents the details and logic of two Fortran computer programs. The program, BRACKET, is designed to evaluate the constant relationship among teeth and orthodontic brackets to which an arch wire is adapted. The program, WIRE, is used to initially fit brackets to teeth using the constants derived in BRACKETS, based upon a series of orthogonal transformations. Subsequently, an orthodontic arch wire is fitted through the brackets, and the results are displayed using computer graphics. It is anticipated that the system would be useful in the orthodontic clinical setting as an aid in arch wire formation. The graphics produce a template which incorporates essential points to consider in arch wire formation, namely, perimeter length, lateral widths, symmetry, and appropriate arch form for the patient.

A computer program for the analysis of dental arch form using the cubic spline function.

This paper presents the details and logic of a FORTRAN computer program which fits a cubic interpolatory spline to a set of data points digitized from an exact size photographic reproduction of a dental model. It also measures the length of the arc and computes a set of normals to the curve to be used in evaluating the error in the fit of the spline. The program is used in studies of dental arch form and is useful in evaluating changes in the form of the arches due to orthodontic treatment. The measurement of the arc length provides an adequate assessment of space available in the dental arch, which is of importance to the orthodontist.