Efficacy of Adjunctives in Periodontal Surgeries: An Evidenced-Based Summary.

Periodontal surgery is required to access the root surfaces in order to debride them of dental plaque and calculus, promote pocket reduction, create healthy bone architecture, and provide patients greater access to out-of-reach areas to maintain oral hygiene. The use of adjunctive agents and materials-enamel matrix derivatives, low-laser treatment, ozone, locally administered minocycline HCL, doxycycline gels, tetracycline fibers, chlorhexidine chips, granular beta-tricalcium phosphate, and hyaluronic acid, and the like-have been reported to improve pocket depth reduction, periodontal ligament healing, bone defect filling, and mechanical debridement during guided tissue regeneration/flap surgeries. However, the efficacy and benefits of these adjuvants compared to periodontal surgery alone is still widely debated. This evidence-based review critically evaluates and summarizes the efficacy of adjuvants used in periodontal surgery that have been reported in the literature.

Long-Term Success of All-Ceramic Dental Implants Compared with Titanium Implants.

All-ceramic dental implants have been identified as a potential alternative to the traditional titanium-based implant systems used in dentistry to satisfy the demands for esthetic metal-free treatment of edentulous jaws. Among the all-ceramic implants introduced in dentistry, zirconia implants have emerged as the forerunner. The success of zirconia as an implant material has paralleled that of titanium in the short-term, however, few clinical studies assess success in the long-term. Failures of zirconia dental implants have been linked to improper operator techniques, manufacturing defects, and unfavorable loading, thereby necessitating optimal quality control measures by manufacturers and proper treatment planning by an experienced operator to reinforce the favorable properties of zirconia as an implant biomaterial. In this comprehensive review, the various implant-related, tissue-related, prosthesis-related, and patient-related factors affecting the success of zirconia implants have been discussed and compared with those of the titanium implant.

Temporomandibular Total Joint Replacement Implant Devices: A Systematic Review of Their Outcomes.

Functional impairment affecting the quality of life results when a wide range of both muscular and joint pathologies affect the temporomandibular joint (TMJ). There are several total temporomandibular joint prosthesis systems available for total joint replacement (TJR). This systematic review provides an overview of the different TJR systems available and discusses their outcomes and efficiency. A systematic review on the outcomes of TJR was performed in October 2020. The five databases searched are PubMed, Europe PMC, Elsevier, SpringerLink, and British Journal of Oral and Maxillofacial Surgery. Outcome measurements were changes in maximal mouth opening (MMO), pain, diet, and functional limitation preoperatively and postoperatively. Seventeen follow-up studies were included in this systematic review, with 1,343 patients. All TMJ implant devices showed significant improvement after placement in all outcomes (pain, diet, MMO). All TJR prostheses showed great improvement comparing preoperative and postoperative outcomes. There was no significant difference between devices when comparing their outcomes.

In vitro study of the soft tissue effects of microsecond-pulsed CO(2) laser parameters during soft tissue incision and sulcular debridement.

BACKGROUND AND OBJECTIVES: Carbon dioxide (CO(2)) lasers are an important part of dental treatment. Advances in laser technology have produced microsecond pulse durations and small beam sizes. The histological effects of porcine intraoral soft tissue with a range of microsecond-pulsed CO(2) laser parameters used for incision and sulcular debridement were evaluated in vitro and compared with historical histologic data. STUDY DESIGN/MATERIALS AND METHODS: Fresh pig mandibles were used to perform incision and sulcular debridement using a microsecond-pulsed CO(2) laser. lambda = 10,600 nm, articulated arm delivered non-contact with spot size 200 microm, 500 microm, and 1 mm, and focal distance of 1 mm. For sulcular debridement, epithelium within periodontal pocket (6 mm x 6 mm) was removed. Laser parameters for incision were from 30 Hz, 350 microseconds, 28 mJ and energy density of 143 J/cm(2) to 90 Hz, 1,000 microseconds, 60 mJ, and 1,911 J/cm(2). Width and depth of tissue removed, as well as coagulation effects of the tissue treated were measured. These were compared to historical histologic database. Laser-treated surfaces were observed qualitatively using scanning electron microscopy (SEM). RESULTS: All laser parameters studied were able to reach the defined simulation objectives in reasonable amounts of time, less than a minute for incision and <20 seconds for sulcular debridement. The depth of the cut was significantly greater than the historical 95% confidence interval, but equivalent for width, lateral, and deep coagulation to the historical database. Sulcular debridement was achieved with minimal coagulation, <100 microm. SEM analysis did not identify any alteration to enamel, dentin, or bone during sulcular debridement. CONCLUSION: The treatment objectives of incision and sulcular debridement were achieved with minimal lateral and deep coagulation in reasonable amount of time. Microsecond-pulsed CO(2) lasers can be safely and effectively used for incision and sulcular debridement.

Considerations on the Use of a Temporary Anchorage Device for Improving Longevity and Success.

Controlled movement of teeth is both a science and an art that relies on applied forces and anchoring or resistance points. The temporary anchorage device (TAD) is a mini-implant that is used as an anchoring point. Applied to appropriate cases with optimal technique, TAD can enhance results. This article discusses the considerations behind increasing longevity of an implant in use and improving its success. Such considerations include implant placement, time before loading, amount of loading, and patient habits.

Dental Students' Clinical Experience Across Three Successive Curricula at One U.S. Dental School.

As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students' clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students' experience at one U.S. dental school. The three were a discipline-based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students' clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students' clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students' clinical experience.

Advances in dental materials.

The use of materials to rehabilitate tooth structures is constantly changing. Over the past decade, newer material processing techniques and technologies have significantly improved the dependability and predictability of dental material for clinicians. The greatest obstacle, however, is in choosing the right combination for continued success. Finding predictable approaches for successful restorative procedures has been the goal of clinical and material scientists. This article provides a broad perspective on the advances made in various classes of dental restorative materials in terms of their functionality with respect to pit and fissure sealants, glass ionomers, and dental composites.